Provider Demographics
NPI:1588001283
Name:OLSON, LISA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:OLSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9401 W THUNDERBIRD RD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4233
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9401 W THUNDERBIRD RD
Practice Address - Street 2:SUITE 190
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4233
Practice Address - Country:US
Practice Address - Phone:623-977-5451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10311225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist