Provider Demographics
NPI:1083766513
Name:OLSEN, JEAN (MA LMT)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:
Last Name:OLSEN
Suffix:
Gender:F
Credentials:MA LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51416
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-0311
Mailing Address - Country:US
Mailing Address - Phone:941-355-3319
Mailing Address - Fax:
Practice Address - Street 1:617 S TAMIAMI TRAIL
Practice Address - Street 2:VENICE CHIROPRACTIC
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285
Practice Address - Country:US
Practice Address - Phone:941-488-6308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLC6544225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC6544OtherBCBS