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General NPI Number Information
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NPI Number | 1053976829
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Entity Type | Individual
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Provider Name | TATE OLSON PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 05/07/2019
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Last Update Date | 05/07/2019
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Provider Practice Location Address
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Address Line | 239 HURFFVILLE CROSSKEYS RD STE 340
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City | SEWELL
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State | NJ
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Zip | 08080-4007
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Country | US
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Telephone | 856-265-0500
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Fax | 856-740-5363
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Provider Business Mailing Address
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Address Line | 224 STRAWBRIDGE DR STE 100
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City | MOORESTOWN
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State | NJ
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Zip | 08057-4602
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Country | US
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Telephone | 856-677-4000
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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 | 40QA01855700
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License Number State | NJ
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