Provider Demographics
NPI:1881142271
Name:OLSON, TYLER J (DPT)
Entity type:Individual
Prefix:MR
First Name:TYLER
Middle Name:J
Last Name:OLSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 3RD AVE W STE 100
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-1679
Mailing Address - Country:US
Mailing Address - Phone:715-682-8000
Mailing Address - Fax:715-682-3145
Practice Address - Street 1:400 3RD AVE W STE 100
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-1679
Practice Address - Country:US
Practice Address - Phone:715-682-8000
Practice Address - Fax:715-682-3145
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI13429-24OtherSTATE OF WI DEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES