Provider Demographics
NPI:1417698770
Name:SANSON, OLIVIA PAIGE (ACSM-CEP, EIM3)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:PAIGE
Last Name:SANSON
Suffix:
Gender:F
Credentials:ACSM-CEP, EIM3
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 S PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-2339
Mailing Address - Country:US
Mailing Address - Phone:479-317-7010
Mailing Address - Fax:
Practice Address - Street 1:209 S PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-2339
Practice Address - Country:US
Practice Address - Phone:479-317-7010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist