Provider Demographics
NPI:1710910435
Name:OLSZAK, DIANNE B (PT)
Entity Type:Individual
Prefix:MRS
First Name:DIANNE
Middle Name:B
Last Name:OLSZAK
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:PO BOX 175
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-0175
Mailing Address - Country:US
Mailing Address - Phone:205-661-0810
Mailing Address - Fax:205-661-9841
Practice Address - Street 1:4901 DEERFOOT PKWY
Practice Address - Street 2:
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173-2697
Practice Address - Country:US
Practice Address - Phone:205-661-0810
Practice Address - Fax:205-661-9841
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH15612251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515010150OtherBLUE CROSS BLUE SHIELD
AL51510149OtherBLUE CROSS BLUE SHIELD
AL650024766OtherRAILROAD MEDICARE
AL51510149OtherBLUE CROSS BLUE SHIELD