Healthcare Provider Details

I. General information

NPI: 1326047879
Provider Name (Legal Business Name): JAMES M OLSON MAPT, MTC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 30TH AVE E SUITE 102
ALEXANDRIA MN
56308-4769
US

IV. Provider business mailing address

410 30TH AVE E SUITE 102
ALEXANDRIA MN
56308-4769
US

V. Phone/Fax

Practice location:
  • Phone: 320-763-5505
  • Fax: 320-763-4447
Mailing address:
  • Phone: 320-763-5505
  • Fax: 320-763-4447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6847
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: