Provider Demographics
NPI:1366412041
Name:OLSON, LOIS OLSON (PT)
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:OLSON
Last Name:OLSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LOIS
Other - Middle Name:E
Other - Last Name:TARAGOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2739 FREMONT AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-1124
Mailing Address - Country:US
Mailing Address - Phone:612-229-7839
Mailing Address - Fax:612-929-5423
Practice Address - Street 1:2739 FREMONT AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-1124
Practice Address - Country:US
Practice Address - Phone:612-229-7839
Practice Address - Fax:612-929-5423
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2979225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist