Provider Demographics
NPI:1972153542
Name:OVERTON, MARLISA CARDOSO (PT, DPT, OCS)
Entity type:Individual
Prefix:DR
First Name:MARLISA
Middle Name:CARDOSO
Last Name:OVERTON
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:MS
Other - First Name:MARLISA
Other - Middle Name:ANNE
Other - Last Name:CARDOSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12123 91ST AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-7904
Mailing Address - Country:US
Mailing Address - Phone:774-232-3632
Mailing Address - Fax:
Practice Address - Street 1:MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:253-968-2252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-16
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13240192251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic