Healthcare Provider Details

I. General information

NPI: 1043616493
Provider Name (Legal Business Name): DOUGLAS OLSON CMT, CMTPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2014
Last Update Date: 11/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1082 ALMADEN VILLAGE LN
SAN JOSE CA
95120-3365
US

IV. Provider business mailing address

1082 ALMADEN VILLAGE LN
SAN JOSE CA
95120-3365
US

V. Phone/Fax

Practice location:
  • Phone: 408-406-1925
  • Fax:
Mailing address:
  • Phone: 408-406-1925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number44401
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: