MEDICARE: MR. ADAM M OLSAVSKY ATC

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
1	2255A2300X	Athletic Trainer	RT003810	PA

General Provider Information

NPI Number	:	1578714598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ADAM M OLSAVSKY ATC

Provider Business Mailing Address
First Line	:	1409 STAPLER PL
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19806-2529
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4201 HENRY AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19144-5409
Country	:	US
Telephone Number	:	215-951-2721
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/08/2008
Last Update Date	:	01/09/2015

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