Healthcare Provider Details

I. General information

NPI: 1437692571
Provider Name (Legal Business Name): ANDREAS OLESEN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2016
Last Update Date: 11/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 NW MIAMI CT
MIAMI FL
33150-3550
US

IV. Provider business mailing address

644 EUCLID AVE APT 2
MIAMI BEACH FL
33139-8659
US

V. Phone/Fax

Practice location:
  • Phone: 305-776-1287
  • Fax:
Mailing address:
  • Phone: 305-776-1287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 32087
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT 32087
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: