Provider Demographics
NPI:1992206189
Name:OLOFSSON, JOSEPH CASEY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:CASEY
Last Name:OLOFSSON
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 W MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-2628
Mailing Address - Country:US
Mailing Address - Phone:815-922-5931
Mailing Address - Fax:
Practice Address - Street 1:528 W MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80521-2628
Practice Address - Country:US
Practice Address - Phone:815-922-5931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-23
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0015982225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist