Provider Demographics
NPI:1871690032
Name:SIMONSSON, OLA A (PT, OCS, MTC)
Entity Type:Individual
Prefix:MR
First Name:OLA
Middle Name:A
Last Name:SIMONSSON
Suffix:
Gender:M
Credentials:PT, OCS, MTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5881 W 16TH ST
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-2910
Mailing Address - Country:US
Mailing Address - Phone:970-313-2775
Mailing Address - Fax:970-313-2777
Practice Address - Street 1:5881 W 16TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-2910
Practice Address - Country:US
Practice Address - Phone:970-313-2775
Practice Address - Fax:970-313-2777
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41612251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO63333821Medicaid
COP00944902OtherMEDICARE RAILROAD CARRIER PTAN
COCOA101997Medicare PIN
COCO300085Medicare PIN
COP00944902OtherMEDICARE RAILROAD CARRIER PTAN