=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326832627
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OLO PHYSICAL THERAPY AND WELLNESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2025
-----------------------------------------------------
Last Update Date | 04/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 680 STATE CIR
-----------------------------------------------------
City | ANN ARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48108-1646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-707-7285
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 680 STATE CIR
-----------------------------------------------------
City | ANN ARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48108-1646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-707-7285
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER OPERATOR
-----------------------------------------------------
Name | JOSEPH OLOFSSON
-----------------------------------------------------
Credential | PT, DPT
-----------------------------------------------------
Telephone | 734-707-7285
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------