Provider Demographics
NPI:1497976450
Name:OLSON, ALEXANDER CARL (ATC)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:CARL
Last Name:OLSON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 CAMDEN CT
Mailing Address - Street 2:
Mailing Address - City:WOODWAY
Mailing Address - State:TX
Mailing Address - Zip Code:76712-8568
Mailing Address - Country:US
Mailing Address - Phone:254-848-9737
Mailing Address - Fax:
Practice Address - Street 1:150 BEAR RUN
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76711-1267
Practice Address - Country:US
Practice Address - Phone:254-710-3064
Practice Address - Fax:254-710-4307
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT15052255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer