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Individual

ANDREW OLSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
1402 MAIN ST, BLOOMER, WI 54724-1637
(715) 568-4669
Mailing address
1731 17TH AVE, BLOOMER, WI 54724-1512
(715) 568-4669
(715) 568-4673

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
10182-024
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
40458300
WI
Enumeration date
05/16/2007
Last updated
12/15/2017
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