Individual
MIRANDA OLSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
2295 S FOOTHILL DR STE 1, SALT LAKE CITY, UT 84109-4006
(801) 486-7542
Mailing address
PO BOX 711185, SALT LAKE CITY, UT 84171-1185
(801) 942-3311
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11772531-2401
UTAH STATE PHYSICAL THERAPIST LICENSE
UT
Enumeration date
06/12/2020
Last updated
06/12/2020
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