Provider Demographics
NPI:1306159587
Name:OLSON, SARAH JEAN (PTA)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:JEAN
Last Name:OLSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:JEAN
Other - Last Name:COLPITTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4125 W POINT LOMA BLVD
Mailing Address - Street 2:APT. 314
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-5606
Mailing Address - Country:US
Mailing Address - Phone:415-341-3884
Mailing Address - Fax:
Practice Address - Street 1:4125 W POINT LOMA BLVD
Practice Address - Street 2:APT. 314
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-5606
Practice Address - Country:US
Practice Address - Phone:415-341-3884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9072225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant