MEDICARE: MR. PETER MICHAEL OLSON PT, 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	225100000X	Physical Therapist	2795	NH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	VX2303	OTHER	NH	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	6400248	OTHER	NH	UNITED HEALTHCARE
4	AA51374	OTHER	NH	HARVARD PILGRIM
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	08Y004081NH05	OTHER	NH	ANTHEM BC/BS
7	1227022	OTHER	NH	AETNA
8	TAX-ID	OTHER	NH	CIGNA
9	001665	OTHER	NH	TRICARE

General Provider Information

NPI Number	:	1881691590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PETER MICHAEL OLSON PT, ATC

Provider Business Mailing Address
First Line	:	58 RANGE RD STE 16
Second Line	:
City	:	WINDHAM
State	:	NH
Zip	:	03087-2026
Country	:	US
Telephone Number	:	603-890-8844
Fax Number	:	603-890-8845

Provider Business Practice Location Address
First Line	:	58 RANGE RD STE 16
Second Line	:
City	:	WINDHAM
State	:	NH
Zip	:	03087-2026
Country	:	US
Telephone Number	:	603-890-8844
Fax Number	:	603-890-8845

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	03/26/2008

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