Healthcare Provider Details

I. General information

NPI: 1558874883
Provider Name (Legal Business Name): SAMUEL S OLMSTEAD DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2017
Last Update Date: 11/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22500 NE MARKETPLACE DR STE 204
REDMOND WA
98053-2033
US

IV. Provider business mailing address

4220 132ND ST SE STE 101
MILL CREEK WA
98012-8999
US

V. Phone/Fax

Practice location:
  • Phone: 425-836-1034
  • Fax:
Mailing address:
  • Phone: 425-316-8046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number60779532
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: