Provider Demographics
NPI:1386816486
Name:OLSEN, KRISTIN (MPT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:OLSEN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:0N139 HOLLAND LN
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-4419
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1002 COMMONS DR
Practice Address - Street 2:SUITE 1002
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2539
Practice Address - Country:US
Practice Address - Phone:630-208-7831
Practice Address - Fax:630-208-9033
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-016318225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK50804Medicare PIN
ILR03934Medicare PIN
ILR03933Medicare PIN
ILR01988Medicare PIN