Provider Demographics
NPI:1881691590
Name:OLSON, PETER MICHAEL (PT, ATC)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:MICHAEL
Last Name:OLSON
Suffix:
Gender:M
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 RANGE RD STE 16
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03087-2026
Mailing Address - Country:US
Mailing Address - Phone:603-890-8844
Mailing Address - Fax:603-890-8845
Practice Address - Street 1:58 RANGE RD STE 16
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:NH
Practice Address - Zip Code:03087-2026
Practice Address - Country:US
Practice Address - Phone:603-890-8844
Practice Address - Fax:603-890-8845
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2795225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30394917Medicaid
NHVX2303OtherMEDICARE
NH6400248OtherUNITED HEALTHCARE
NHAA51374OtherHARVARD PILGRIM
MA0715743Medicaid
NH08Y004081NH05OtherANTHEM BC/BS
NH1227022OtherAETNA
NHTAX-IDOtherCIGNA
NH001665OtherTRICARE