Healthcare Provider Details

I. General information

NPI: 1417698770
Provider Name (Legal Business Name): OLIVIA PAIGE SANSON ACSM-CEP, EIM3
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2022
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 S PORTLAND AVE
RUSSELLVILLE AR
72801-2339
US

IV. Provider business mailing address

209 S PORTLAND AVE
RUSSELLVILLE AR
72801-2339
US

V. Phone/Fax

Practice location:
  • Phone: 479-317-7010
  • Fax:
Mailing address:
  • Phone: 479-317-7010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: