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Organization
CREEK SIDE ORTHOPEDIC
Active
Organization
CREEK SIDE ORTHOPEDIC
Active
Other names
Creek side Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD R. OLSON R.P.T. (PRESIDENT)
(805) 543-5633
Entity
Organization
Contact information
Practice address
1545 HIGUERA ST, SAN LUIS OBISPO, CA 93401-2917
(805) 543-5633
(805) 543-5990
Mailing address
1545 HIGUERA ST, SAN LUIS OBISPO, CA 93401-2917
(805) 543-5633
(805) 543-5990
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1813761
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ40093Z
BLUE SHIELD PIN
CA
Enumeration date
11/29/2005
Last updated
03/26/2015
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