Healthcare Provider Details

I. General information

NPI: 1184283293
Provider Name (Legal Business Name): CONNOR DAVID OLSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 19TH ST NW STE 200
ROCHESTER MN
55901-6606
US

IV. Provider business mailing address

PO BOX 7197
ROCHESTER MN
55903-7197
US

V. Phone/Fax

Practice location:
  • Phone: 507-322-3460
  • Fax:
Mailing address:
  • Phone: 507-322-3460
  • Fax: 605-541-0109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11469
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: