Basic Information
| Provider Information | |||||||||
| NPI: | 1003803750 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OLIVERO | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 MARJORIE TRL | ||||||||
| Address2: | |||||||||
| City: | ORMOND BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321748501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3866737904 | ||||||||
| FaxNumber: | 3866737904 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 MARJORIE TRL | ||||||||
| Address2: | |||||||||
| City: | ORMOND BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321748501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3866737904 | ||||||||
| FaxNumber: | 3866737904 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2005 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | MA-31267 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
ID Information
| ID | Type | State | Issuer | Description | C2727 | 01 | FL | BCBS - MASSAGE THERAPY | OTHER |