Healthcare Provider Details

I. General information

NPI: 1043229362
Provider Name (Legal Business Name): DIAZ-OLSON PHYSICAL THERAPY AND SPORTS REHABILITATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 08/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

448 E EL CAMINO REAL
SUNNYVALE CA
94087
US

IV. Provider business mailing address

452 E EL CAMINO REAL
SUNNYVALE CA
94087-1938
US

V. Phone/Fax

Practice location:
  • Phone: 408-245-3575
  • Fax: 408-245-3576
Mailing address:
  • Phone: 408-245-3575
  • Fax: 408-245-3576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL NEAL OLSON
Title or Position: CEO
Credential: PT
Phone: 408-245-3575