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General NPI Number Information
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NPI Number | 1780448944
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Entity Type | Individual
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Provider Name | TODD ALLEN OLESON
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Gender | Male
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Dates
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Enumeration Date | 02/08/2024
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Last Update Date | 02/08/2024
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Provider Practice Location Address
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Address Line | 2558 S BRENTWOOD BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63144-2309
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Country | US
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Telephone | 314-961-8940
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Fax | 314-961-8969
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Provider Business Mailing Address
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Address Line | 1958A WITHNELL AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63118-2517
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Country | US
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Telephone | 314-420-5179
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2023028468
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License Number State | MO
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