Provider Demographics
NPI:1063243772
Name:OLIVEIRA, LUIS GUSTAVO (DPT)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:GUSTAVO
Last Name:OLIVEIRA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6507 107TH TER N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782-2432
Mailing Address - Country:US
Mailing Address - Phone:708-374-2758
Mailing Address - Fax:
Practice Address - Street 1:1206 COURT ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-5802
Practice Address - Country:US
Practice Address - Phone:727-286-8408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL41901225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist