Healthcare Provider Details

I. General information

NPI: 1407293616
Provider Name (Legal Business Name): NATHAN MICHAEL OLSON DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2013
Last Update Date: 05/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E 28TH ST
MINNEAPOLIS MN
55407-3723
US

IV. Provider business mailing address

138 2ND ST
AMERY WI
54001-1634
US

V. Phone/Fax

Practice location:
  • Phone: 715-607-0404
  • Fax:
Mailing address:
  • Phone: 715-607-0404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: