Provider Demographics
NPI:1437520590
Name:OLIVER, ANTOINE TYRONE (LMT; REFLEXOLOGIST)
Entity type:Individual
Prefix:
First Name:ANTOINE
Middle Name:TYRONE
Last Name:OLIVER
Suffix:
Gender:M
Credentials:LMT; REFLEXOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21679 HORSESHOE DR
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365-6499
Mailing Address - Country:US
Mailing Address - Phone:713-969-0743
Mailing Address - Fax:
Practice Address - Street 1:5539 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-6615
Practice Address - Country:US
Practice Address - Phone:713-969-0743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-15
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
173C00000X, 174400000X
TXMT122240225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No173C00000XOther Service ProvidersReflexologist
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXMT122240OtherLICENSED MASSAGE THERAPIST