Provider Demographics
NPI:1942235494
Name:OLSON, JOHN F (PT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:OLSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 S PIONEER RD # 100
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-3871
Mailing Address - Country:US
Mailing Address - Phone:920-922-7776
Mailing Address - Fax:920-922-2938
Practice Address - Street 1:103 S PIONEER RD # 100
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-3871
Practice Address - Country:US
Practice Address - Phone:920-922-7776
Practice Address - Fax:920-922-2938
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3304-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40213600Medicaid
WI40213600Medicaid