Healthcare Provider Details

I. General information

NPI: 1578312138
Provider Name (Legal Business Name): ALEXANDRA MARIE OLSON DPT, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2024
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12925 BOOKER T WASHINGTON HWY STE 200
HARDY VA
24101-3972
US

IV. Provider business mailing address

5500 13TH AVE
VIENNA WV
26105-3155
US

V. Phone/Fax

Practice location:
  • Phone: 540-296-4840
  • Fax: 434-509-1695
Mailing address:
  • Phone: 304-210-4415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT001773
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP048701T
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP060852T
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT004910
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: