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NPI Code Detail

MEDICARE: RYAN OLSON PT

MEDICARE: RYAN OLSON PT
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 Therapist070022391IL
2225100000XPhysical Therapist13624 - 24WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1070022391OTHERILIL PT LICENSE
213624 - 24OTHERWIWI PT LICENSE

General Provider Information

NPI Number : 1629529623
Entity Type Code : Individual
Provider Name (Legal Business Name) : RYAN OLSON PT
Provider Business Mailing Address
First Line : PO BOX 720908
Second Line :
City : NORMAN
State : OK
Zip : 73070-4708
Country : US
Telephone Number : 405-809-8713
Fax Number :
Provider Business Practice Location Address
First Line : 1266 W MAIN ST
Second Line :
City : SUN PRAIRIE
State : WI
Zip : 53590-1918
Country : US
Telephone Number : 608-318-1357
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2016
Last Update Date : 03/29/2021

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