Individual
TERRY OLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
401 E COLFAX AVE, SUITE 102, SOUTH BEND, IN 46617-2737
(574) 234-1059
Mailing address
401 E COLFAX AVE, SUITE 102, SOUTH BEND, IN 46617-2737
(574) 234-1059
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05001456A
LICENSE
IN
Enumeration date
09/07/2006
Last updated
10/05/2007
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