Provider Demographics
NPI:1700042587
Name:OLSEN, RUBY M (LMP)
Entity Type:Individual
Prefix:MRS
First Name:RUBY
Middle Name:M
Last Name:OLSEN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 SE 146TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-8434
Mailing Address - Country:US
Mailing Address - Phone:360-991-1342
Mailing Address - Fax:360-397-0139
Practice Address - Street 1:415 SE 177TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-4201
Practice Address - Country:US
Practice Address - Phone:360-991-1342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020683172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist