Provider Demographics
NPI:1508921735
Name:OLSSON, ULRIK JOHN (PT MTC)
Entity Type:Individual
Prefix:
First Name:ULRIK
Middle Name:JOHN
Last Name:OLSSON
Suffix:
Gender:M
Credentials:PT MTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 KENNEDY AVE
Mailing Address - Street 2:STE 3
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-7555
Mailing Address - Country:US
Mailing Address - Phone:970-256-0868
Mailing Address - Fax:970-255-0469
Practice Address - Street 1:403 KENNEDY AVE
Practice Address - Street 2:STE 3
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-7555
Practice Address - Country:US
Practice Address - Phone:970-256-0868
Practice Address - Fax:970-255-0469
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4462225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1508921735Medicare PIN