Provider Demographics
NPI:1609953009
Name:OLSON, SHARON ANN (PT)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:ANN
Last Name:OLSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4328 RUSTIC PL
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-6247
Mailing Address - Country:US
Mailing Address - Phone:651-482-9277
Mailing Address - Fax:
Practice Address - Street 1:1570 BEAM AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1166
Practice Address - Country:US
Practice Address - Phone:651-326-1940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5860225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN304P7OLOtherBCBS