Provider Demographics
NPI:1699556969
Name:OLIVAS ROJO, LUIS H (LMT)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:H
Last Name:OLIVAS ROJO
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3241 LIVINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-3735
Mailing Address - Country:US
Mailing Address - Phone:817-706-5648
Mailing Address - Fax:
Practice Address - Street 1:3241 LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-3735
Practice Address - Country:US
Practice Address - Phone:817-706-5648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT138897225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist