Provider Demographics
NPI:1598045940
Name:OLSON, KRISTIAN (PT)
Entity Type:Individual
Prefix:
First Name:KRISTIAN
Middle Name:
Last Name:OLSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5985 RICE CREEK PKWY
Mailing Address - Street 2:STE 104
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-5036
Mailing Address - Country:US
Mailing Address - Phone:651-484-6735
Mailing Address - Fax:651-484-5663
Practice Address - Street 1:4625 CHURCHILL ST
Practice Address - Street 2:SUITE 204
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-5868
Practice Address - Country:US
Practice Address - Phone:651-484-6735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-17
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8821225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist