Provider Demographics
NPI:1265293336
Name:OLSEN, KRISTYN (LMT)
Entity type:Individual
Prefix:
First Name:KRISTYN
Middle Name:
Last Name:OLSEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2357 W 1800 S
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-6223
Mailing Address - Country:US
Mailing Address - Phone:801-871-9323
Mailing Address - Fax:385-831-7938
Practice Address - Street 1:67 E 100 N
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-4624
Practice Address - Country:US
Practice Address - Phone:801-871-9323
Practice Address - Fax:385-333-7202
Is Sole Proprietor?:No
Enumeration Date:2024-01-17
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13412250-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist