Provider Demographics
NPI:1023160181
Name:OLSEN, ERIN DONOVAN (PT)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:DONOVAN
Last Name:OLSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 BLUE BONNET PL
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1963
Mailing Address - Country:US
Mailing Address - Phone:760-632-2495
Mailing Address - Fax:760-632-2495
Practice Address - Street 1:1830 BLUE BONNET PL
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-1963
Practice Address - Country:US
Practice Address - Phone:760-632-2495
Practice Address - Fax:760-632-2495
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT22270225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT22700OtherBLUE SHIELD PROVIDER ID
CA0PT22700OtherBLUE SHIELD PROVIDER ID