Healthcare Provider Details

I. General information

NPI: 1770544421
Provider Name (Legal Business Name): JILL ANNE OLSON P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 MULLAN RD STE. D, PEAK PERFORMANCE PT, PC,
MISSOULA MT
59808-1811
US

IV. Provider business mailing address

2360 MULLAN RD STE. D
MISSOULA MT
59808-1811
US

V. Phone/Fax

Practice location:
  • Phone: 406-542-0808
  • Fax: 406-542-0909
Mailing address:
  • Phone: 406-542-0808
  • Fax: 406-542-0909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number379
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: