Healthcare Provider Details

I. General information

NPI: 1972725836
Provider Name (Legal Business Name): MICHAEL J OLMSTEAD P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 11/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 W S BOUNDARY ST STE 200
PERRYSBURG OH
43551-5278
US

IV. Provider business mailing address

1090 W S BOUNDARY ST STE 200
PERRYSBURG OH
43551-5278
US

V. Phone/Fax

Practice location:
  • Phone: 419-872-1914
  • Fax: 419-872-1910
Mailing address:
  • Phone: 419-872-1914
  • Fax: 419-872-1910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT4650
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: