Provider Demographics
NPI:1831152917
Name:OLSON, WILLIAM (PT)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:OLSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:14120 N NEWPORT HWY
Practice Address - Street 2:SUITE B
Practice Address - City:MEAD
Practice Address - State:WA
Practice Address - Zip Code:99021-8600
Practice Address - Country:US
Practice Address - Phone:509-468-4861
Practice Address - Fax:509-468-2101
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00006841225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1831152917Medicaid
WAP00977515OtherRR MEDICARE
WA1831152917Medicaid
WAG8869958Medicare PIN