Healthcare Provider Details

I. General information

NPI: 1235478843
Provider Name (Legal Business Name): TIMOTHY R OLSEN PA-C, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2013
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 LANGHORNE RD
LYNCHBURG VA
24501-1423
US

IV. Provider business mailing address

2125 LANGHORNE RD
LYNCHBURG VA
24501-1423
US

V. Phone/Fax

Practice location:
  • Phone: 434-200-3600
  • Fax: 434-847-1219
Mailing address:
  • Phone: 434-200-3600
  • Fax: 434-847-1219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SN0800X
TaxonomyNeuroscience Clinical Nurse Specialist
License Number0110005939
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110005939
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: