Healthcare Provider Details

I. General information

NPI: 1538719497
Provider Name (Legal Business Name): BRIAN OLMSTEAD DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2019
Last Update Date: 09/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4240 BLUE RIDGE BLVD
KANSAS CITY MO
64133-1713
US

IV. Provider business mailing address

2911 GRAND AVE
KANSAS CITY MO
64108-3221
US

V. Phone/Fax

Practice location:
  • Phone: 816-897-3415
  • Fax:
Mailing address:
  • Phone: 816-803-2079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1105611
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: