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NPI Code Detail

MEDICARE: MARK W OLSON MPT

MEDICARE:   MARK W OLSON  MPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist7080CO

General Provider Information

NPI Number : 1467630970
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK W OLSON MPT
Provider Business Mailing Address
First Line : 7222 COMMERCE CENTER DR
Second Line : SUITE 100
City : COLORADO SPRINGS
State : CO
Zip : 80919-2630
Country : US
Telephone Number : 719-574-5562
Fax Number : 719-471-0445
Provider Business Practice Location Address
First Line : 7222 COMMERCE CENTER DR
Second Line : SUITE 100
City : COLORADO SPRINGS
State : CO
Zip : 80919-2630
Country : US
Telephone Number : 719-574-5562
Fax Number : 719-471-0445
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2008
Last Update Date : 02/06/2008

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