Healthcare Provider Details

I. General information

NPI: 1306730858
Provider Name (Legal Business Name): ALEX OLVER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2025
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4602 EASTPARK BLVD
MADISON WI
53718-2002
US

IV. Provider business mailing address

6251 FOX RUN
DEFOREST WI
53532-2853
US

V. Phone/Fax

Practice location:
  • Phone: 608-440-6400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number17291
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: