Individual
MR. KENNETH ROBERT OLSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1802 DOWLING ST, KENDALLVILLE, IN 46755
(260) 347-4374
Mailing address
2916 L. HUNTINGTON RD., FT. WAYNE, IN 46809-2619
(260) 242-3290
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06003749A
IN
Other
Enumeration date
09/06/2012
Last updated
09/06/2012
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