Provider Demographics
NPI:1467630970
Name:OLSON, MARK W (MPT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:W
Last Name:OLSON
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:7222 COMMERCE CENTER DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-2630
Mailing Address - Country:US
Mailing Address - Phone:719-574-5562
Mailing Address - Fax:719-471-0445
Practice Address - Street 1:7222 COMMERCE CENTER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-2630
Practice Address - Country:US
Practice Address - Phone:719-574-5562
Practice Address - Fax:719-471-0445
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7080225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist