Provider Demographics
NPI:1447944533
Name:OLIVER, SIMONE DAPHNE
Entity type:Individual
Prefix:MS
First Name:SIMONE
Middle Name:DAPHNE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 MEADOWLANE DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-1943
Mailing Address - Country:US
Mailing Address - Phone:216-410-7692
Mailing Address - Fax:
Practice Address - Street 1:21625 CHAGRIN BLVD STE 240
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5335
Practice Address - Country:US
Practice Address - Phone:216-714-3330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-02
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist