Provider Demographics
NPI:1235478843
Name:OLSEN, TIMOTHY R (PA-C, ATC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:R
Last Name:OLSEN
Suffix:
Gender:M
Credentials:PA-C, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 TATE SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-1116
Mailing Address - Country:US
Mailing Address - Phone:434-200-3600
Mailing Address - Fax:434-847-1219
Practice Address - Street 1:2025 TATE SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1116
Practice Address - Country:US
Practice Address - Phone:434-200-3600
Practice Address - Fax:434-847-1219
Is Sole Proprietor?:No
Enumeration Date:2013-02-04
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110005939363A00000X
VA0110-005939363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant