Provider Demographics
NPI:1629809652
Name:OLSON, SOPHIA (DPT)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:OLSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7594 OAK HILL RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55129-4415
Mailing Address - Country:US
Mailing Address - Phone:651-295-7751
Mailing Address - Fax:
Practice Address - Street 1:5050 W 36TH ST STE 100
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-5470
Practice Address - Country:US
Practice Address - Phone:952-925-4085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN13654225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist