Provider Demographics
NPI:1184883332
Name:OLSON, HEIDI LYNN (PTA)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:LYNN
Last Name:OLSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 NORTH 5TH STREET
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-3348
Mailing Address - Country:US
Mailing Address - Phone:218-829-4231
Mailing Address - Fax:218-825-3855
Practice Address - Street 1:224 N 5TH ST
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-3348
Practice Address - Country:US
Practice Address - Phone:218-829-4231
Practice Address - Fax:218-825-3855
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant