MEDICARE: TODD ALLEN OLESON

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	225200000X	Physical Therapy Assistant	2023028468	MO

General Provider Information

NPI Number	:	1780448944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TODD ALLEN OLESON

Provider Business Mailing Address
First Line	:	1958A WITHNELL AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63118-2517
Country	:	US
Telephone Number	:	314-420-5179
Fax Number	:

Provider Business Practice Location Address
First Line	:	2558 S BRENTWOOD BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63144-2309
Country	:	US
Telephone Number	:	314-961-8940
Fax Number	:	314-961-8969

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

Provider Enumeration Date	:	02/08/2024
Last Update Date	:	02/08/2024

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Directions to “ TODD ALLEN OLESON ” Practice Location

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