Provider Demographics
NPI:1134260862
Name:OLSON, PRESTON RUSSELL (DPT)
Entity type:Individual
Prefix:DR
First Name:PRESTON
Middle Name:RUSSELL
Last Name:OLSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 OVERLOOK RD
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-7144
Mailing Address - Country:US
Mailing Address - Phone:954-224-2649
Mailing Address - Fax:954-252-2149
Practice Address - Street 1:3340 OVERLOOK RD
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-7144
Practice Address - Country:US
Practice Address - Phone:954-224-2649
Practice Address - Fax:954-252-2149
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19749225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL887061600Medicaid
FL887061600Medicaid