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General NPI Number Information
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NPI Number | 1053960468
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Entity Type | Individual
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Provider Name | ANDREA LYNN OLSEN PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 09/09/2019
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Last Update Date | 09/09/2019
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Provider Practice Location Address
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Address Line | 314 CENTRAL AVE STE 2A
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City | LINWOOD
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State | NJ
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Zip | 08221-2005
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Country | US
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Telephone | 609-365-8499
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Fax |
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Provider Business Mailing Address
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Address Line | 649 13TH ST
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City | HAMMONTON
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State | NJ
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Zip | 08037-8618
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Country | US
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Telephone | 609-402-7756
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA01885500
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License Number State | NJ
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