Provider Demographics
NPI:1952515272
Name:OLSEN, DONALD L (EDD, PT, OCS)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:L
Last Name:OLSEN
Suffix:
Gender:M
Credentials:EDD, PT, OCS
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Mailing Address - Street 1:24014 W RENWICK RD
Mailing Address - Street 2:STE F
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-8708
Mailing Address - Country:US
Mailing Address - Phone:800-974-4378
Mailing Address - Fax:630-515-1536
Practice Address - Street 1:4922 COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-9188
Practice Address - Country:US
Practice Address - Phone:262-377-4077
Practice Address - Fax:262-377-7358
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16012251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40010100Medicaid