Provider Demographics
NPI:1578932075
Name:OLSON, JENNA (PTA)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:
Last Name:OLSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:ALMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:PO BOX 436
Mailing Address - Street 2:1320 4TH
Mailing Address - City:HAMPTON
Mailing Address - State:IA
Mailing Address - Zip Code:50441-1104
Mailing Address - Country:US
Mailing Address - Phone:641-357-5056
Mailing Address - Fax:
Practice Address - Street 1:509 BUDDY HOLLY PL
Practice Address - Street 2:
Practice Address - City:CLEAR LAKE
Practice Address - State:IA
Practice Address - Zip Code:50428-1359
Practice Address - Country:US
Practice Address - Phone:641-357-5056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-15
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001361225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant