Provider Demographics
NPI:1396160909
Name:OLSON, KELLY R (PT)
Entity type:Individual
Prefix:MR
First Name:KELLY
Middle Name:R
Last Name:OLSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3277 E LOUISE DR
Mailing Address - Street 2:SUITE 410
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-9359
Mailing Address - Country:US
Mailing Address - Phone:208-489-5800
Mailing Address - Fax:208-489-4065
Practice Address - Street 1:3277 E LOUISE DR
Practice Address - Street 2:SUITE 410
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-9359
Practice Address - Country:US
Practice Address - Phone:208-489-5800
Practice Address - Fax:208-489-4065
Is Sole Proprietor?:No
Enumeration Date:2014-02-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDRPT610225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist