Healthcare Provider Details

I. General information

NPI: 1669974564
Provider Name (Legal Business Name): LAUREN OLSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 03/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 ROBERT DANIEL DR
DANIEL ISLAND SC
29492-7329
US

IV. Provider business mailing address

1129 WATERFRONT DR
MOUNT PLEASANT SC
29464-7428
US

V. Phone/Fax

Practice location:
  • Phone: 832-324-7266
  • Fax:
Mailing address:
  • Phone: 843-324-7266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: