Provider Demographics
NPI:1366742553
Name:OLSON, KIZMI LEVENS (PT)
Entity type:Individual
Prefix:MRS
First Name:KIZMI
Middle Name:LEVENS
Last Name:OLSON
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 1:2625 E. OLD MINER RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303
Mailing Address - Country:US
Mailing Address - Phone:620-714-0451
Mailing Address - Fax:
Practice Address - Street 1:8128 E FLORENTINE RD STE A
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-8484
Practice Address - Country:US
Practice Address - Phone:928-775-6811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-22
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10229225100000X
KS11-03575225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist