Healthcare Provider Details

I. General information

NPI: 1629858816
Provider Name (Legal Business Name): HOLDEN DAVIS OLSON DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2023
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 MAPLE GROVE RD STE 200
DULUTH MN
55811-1824
US

IV. Provider business mailing address

2512 HUTCHINSON RD
DULUTH MN
55811-2917
US

V. Phone/Fax

Practice location:
  • Phone: 218-722-9300
  • Fax:
Mailing address:
  • Phone: 218-213-7606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number16557
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13291
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: