Basic Information
| Provider Information | |||||||||
| NPI: | 1861792509 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OLSON | ||||||||
| FirstName: | CARL | ||||||||
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| Credential: | D.P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5036 JERICHO TPKE | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | COMMACK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117252812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314865286 | ||||||||
| FaxNumber: | 6314865287 | ||||||||
| Practice Location | |||||||||
| Address1: | 5036 JERICHO TPKE | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | COMMACK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117252812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314865286 | ||||||||
| FaxNumber: | 6314865287 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2010 | ||||||||
| LastUpdateDate: | 10/27/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 032366 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.