Provider Demographics
NPI:1235755265
Name:OLSON, ANDREW ROLAND (DPT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:ROLAND
Last Name:OLSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 KRUGER AVE
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:WI
Mailing Address - Zip Code:54822-9571
Mailing Address - Country:US
Mailing Address - Phone:715-651-8113
Mailing Address - Fax:
Practice Address - Street 1:1507 W KNAPP ST UNIT 1
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-1384
Practice Address - Country:US
Practice Address - Phone:715-236-3610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15125-242251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic