Provider Demographics
NPI:1396905360
Name:OLSON, CLAYTON PAUL (PTA)
Entity type:Individual
Prefix:
First Name:CLAYTON
Middle Name:PAUL
Last Name:OLSON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2442 NW MARKET ST
Mailing Address - Street 2:# 510
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-4137
Mailing Address - Country:US
Mailing Address - Phone:206-284-7012
Mailing Address - Fax:206-691-0615
Practice Address - Street 1:2717 DEXTER AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-1914
Practice Address - Country:US
Practice Address - Phone:206-284-7012
Practice Address - Fax:206-691-0615
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7883225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant