Healthcare Provider Details

I. General information

NPI: 1700458080
Provider Name (Legal Business Name): DANIEL JAMES OLMSCHENK DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2021
Last Update Date: 07/15/2021
Certification Date: 08/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 MAGGIES POND RD
GREENSBORO VT
05841-8800
US

IV. Provider business mailing address

1218 JOHN FOWLER RD
PLAINFIELD VT
05667-9392
US

V. Phone/Fax

Practice location:
  • Phone: 802-533-7051
  • Fax:
Mailing address:
  • Phone: 651-210-8403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number040.0134166
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: