Healthcare Provider Details

I. General information

NPI: 1699294355
Provider Name (Legal Business Name): WILLIAM OLSEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2017
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 BERRY CHASE PL
MONTGOMERY AL
36117-6896
US

IV. Provider business mailing address

PO BOX 242983
MONTGOMERY AL
36124-2983
US

V. Phone/Fax

Practice location:
  • Phone: 334-356-6453
  • Fax: 334-239-8126
Mailing address:
  • Phone: 334-356-6453
  • Fax: 334-356-6453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH11397
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: