Provider Demographics
NPI:1285961144
Name:OLEVITCH, SANFORD ALAN (PT)
Entity type:Individual
Prefix:MR
First Name:SANFORD
Middle Name:ALAN
Last Name:OLEVITCH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:SANDY
Other - Middle Name:A
Other - Last Name:OLEVITCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:8206 W 35TH ST
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-3815
Mailing Address - Country:US
Mailing Address - Phone:612-727-1167
Mailing Address - Fax:612-767-3525
Practice Address - Street 1:4080 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-5604
Practice Address - Country:US
Practice Address - Phone:763-398-8888
Practice Address - Fax:763-398-0670
Is Sole Proprietor?:No
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6731225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist