Provider Demographics
NPI:1841466752
Name:OLMSTED, MARK (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:OLMSTED
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11937 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:DES PERES
Mailing Address - State:MO
Mailing Address - Zip Code:63131-4502
Mailing Address - Country:US
Mailing Address - Phone:314-822-4400
Mailing Address - Fax:314-822-4111
Practice Address - Street 1:11937 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:DES PERES
Practice Address - State:MO
Practice Address - Zip Code:63131-4502
Practice Address - Country:US
Practice Address - Phone:314-822-4400
Practice Address - Fax:314-822-4111
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007028026225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist