MEDICARE: NATHAN W OLSON P.T.

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	225100000X	Physical Therapist	2318	NE

General Provider Information

NPI Number	:	1417244328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHAN W OLSON P.T.

Provider Business Mailing Address
First Line	:	PO BOX 211
Second Line	:
City	:	DAVID CITY
State	:	NE
Zip	:	68632-0211
Country	:	US
Telephone Number	:	402-367-1250
Fax Number	:

Provider Business Practice Location Address
First Line	:	303 BROADWAY ST
Second Line	:
City	:	FULLERTON
State	:	NE
Zip	:	68638-3152
Country	:	US
Telephone Number	:	308-536-3244
Fax Number	:

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

Provider Enumeration Date	:	06/30/2011
Last Update Date	:	05/17/2016

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