Provider Demographics
NPI:1942369053
Name:OLSSON PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:OLSSON PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ULRIK
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:OLSSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT MTC
Authorized Official - Phone:970-256-0868
Mailing Address - Street 1:403 KENNEDY AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-7555
Mailing Address - Country:US
Mailing Address - Phone:970-256-0868
Mailing Address - Fax:970-255-0469
Practice Address - Street 1:403 KENNEDY AVE STE 3
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-7555
Practice Address - Country:US
Practice Address - Phone:970-256-0868
Practice Address - Fax:970-255-0469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCF5503Medicare ID - Type Unspecified