Provider Demographics
NPI:1124367073
Name:OLSON, BRYAN DANIEL (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:DANIEL
Last Name:OLSON
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 LUPI CT
Mailing Address - Street 2:SUITE 150
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-4761
Mailing Address - Country:US
Mailing Address - Phone:386-447-0011
Mailing Address - Fax:386-447-0161
Practice Address - Street 1:31 LUPI CT
Practice Address - Street 2:SUITE 150
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-4761
Practice Address - Country:US
Practice Address - Phone:386-447-0011
Practice Address - Fax:386-447-0161
Is Sole Proprietor?:No
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT28122225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist