Provider Demographics
NPI:1629858816
Name:OLSON, HOLDEN DAVIS (DPT)
Entity Type:Individual
Prefix:DR
First Name:HOLDEN
Middle Name:DAVIS
Last Name:OLSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2512 HUTCHINSON RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-2917
Mailing Address - Country:US
Mailing Address - Phone:218-213-7606
Mailing Address - Fax:
Practice Address - Street 1:2806 BELKNAP ST
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-2341
Practice Address - Country:US
Practice Address - Phone:715-392-4078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN13291225100000X
WI16557225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist