Provider Demographics
NPI:1881993939
Name:OLSON, BETH ERIN (DPT)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:ERIN
Last Name:OLSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:ERIN
Other - Last Name:MCNEIL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5799
Mailing Address - Country:US
Mailing Address - Phone:904-829-3411
Mailing Address - Fax:
Practice Address - Street 1:1 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5799
Practice Address - Country:US
Practice Address - Phone:904-829-3411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-15
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist