Healthcare Provider Details

I. General information

NPI: 1184167181
Provider Name (Legal Business Name): JESSICA LYNN REYES OLSSON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2016
Last Update Date: 11/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3183 SW 38TH CT
MIAMI FL
33146-1528
US

IV. Provider business mailing address

345 NW 34TH ST APT 3
MIAMI FL
33127-3455
US

V. Phone/Fax

Practice location:
  • Phone: 305-501-0231
  • Fax:
Mailing address:
  • Phone: 305-879-7795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT32153
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: