Provider Demographics
NPI:1346619517
Name:OLSON, KAITLEN ALEXIS (PT)
Entity type:Individual
Prefix:
First Name:KAITLEN
Middle Name:ALEXIS
Last Name:OLSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6152 CELESTITE AVE
Mailing Address - Street 2:
Mailing Address - City:ALTA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-3123
Mailing Address - Country:US
Mailing Address - Phone:951-452-2131
Mailing Address - Fax:
Practice Address - Street 1:10350 BARNES CANYON RD STE 200
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2709
Practice Address - Country:US
Practice Address - Phone:858-455-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-17
Last Update Date:2023-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42912225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist