Provider Demographics
NPI:1326047879
Name:OLSON, JAMES M (MAPT, MTC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:M
Last Name:OLSON
Suffix:
Gender:M
Credentials:MAPT, MTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:410 30TH AVE E
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-4769
Mailing Address - Country:US
Mailing Address - Phone:320-763-5505
Mailing Address - Fax:320-763-4447
Practice Address - Street 1:410 30TH AVE E
Practice Address - Street 2:SUITE 102
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-4769
Practice Address - Country:US
Practice Address - Phone:320-763-5505
Practice Address - Fax:320-763-4447
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN6847225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN482487300Medicaid
MN482487300Medicaid