Provider Demographics
NPI:1043460140
Name:TASH, OLIVIA DEEANNA (PT,LMT)
Entity type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:DEEANNA
Last Name:TASH
Suffix:
Gender:F
Credentials:PT,LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 SONOMA DR
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33594-3041
Mailing Address - Country:US
Mailing Address - Phone:813-679-2925
Mailing Address - Fax:
Practice Address - Street 1:749 W LUMSDEN RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-6261
Practice Address - Country:US
Practice Address - Phone:813-681-6333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM37863225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist