Healthcare Provider Details

I. General information

NPI: 1750896551
Provider Name (Legal Business Name): SONJA MARIE NORTHRUP-OLSON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2017
Last Update Date: 12/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E 21ST ST
SIOUX FALLS SD
57105-1016
US

IV. Provider business mailing address

709 S LITTLE BROOK LN
SIOUX FALLS SD
57106-7830
US

V. Phone/Fax

Practice location:
  • Phone: 504-322-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0511
License Number StateSD

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: