Provider Demographics
NPI:1003497116
Name:OLSON, DEREK S (DPT)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:S
Last Name:OLSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1650 LYNDON FARM CT STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5005
Mailing Address - Country:US
Mailing Address - Phone:334-231-5364
Mailing Address - Fax:334-513-7138
Practice Address - Street 1:1307 NE 102ND AVE STE T-1
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-3980
Practice Address - Country:US
Practice Address - Phone:971-270-0913
Practice Address - Fax:971-270-0914
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
225100000X
CA302169225100000X
OR65111225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist