MEDICARE: RAFAEL JESUS OLIVA PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	PT16788	FL
2	225100000X	Physical Therapist	16788	FL
3	2251X0800X	Orthopedic Physical Therapist	16788	FL
4	225100000X	Physical Therapist	PT16788	FL

General Provider Information

NPI Number	:	1235279662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAFAEL JESUS OLIVA PT

Provider Business Mailing Address
First Line	:	9888 SW 7TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33174-1985
Country	:	US
Telephone Number	:	786-797-5707
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 S DOUGLAS RD STE 210
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-4108
Country	:	US
Telephone Number	:	305-448-0146
Fax Number	:	305-448-0147

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	10/14/2024

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