Healthcare Provider Details

I. General information

NPI: 1396905360
Provider Name (Legal Business Name): CLAYTON PAUL OLSON PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2008
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2717 DEXTER AVE N
SEATTLE WA
98109-1914
US

IV. Provider business mailing address

2442 NW MARKET ST # 510
SEATTLE WA
98107-4137
US

V. Phone/Fax

Practice location:
  • Phone: 206-284-7012
  • Fax: 206-691-0615
Mailing address:
  • Phone: 206-284-7012
  • Fax: 206-691-0615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number7883
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: