Provider Demographics
NPI:1881843456
Name:OLSEN, SIMONE STAKICH (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:SIMONE
Middle Name:STAKICH
Last Name:OLSEN
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
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Mailing Address - Street 1:4560 SE INTERNATIONAL WAY, SUITE 100
Mailing Address - Street 2:CONSONUS HEALTHCARE SERVICES
Mailing Address - City:MILWUAKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222
Mailing Address - Country:US
Mailing Address - Phone:971-206-5200
Mailing Address - Fax:971-206-5209
Practice Address - Street 1:4560 SE INTERNATIONAL WAY, SUITE 100
Practice Address - Street 2:CONSONUS HEALTHCARE SERVICES
Practice Address - City:MILWUAKIE
Practice Address - State:OR
Practice Address - Zip Code:97222
Practice Address - Country:US
Practice Address - Phone:971-206-5200
Practice Address - Fax:971-206-5209
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA34325225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist