Provider Demographics
NPI:1750005922
Name:OLSON, CERISE (DPT)
Entity type:Individual
Prefix:
First Name:CERISE
Middle Name:
Last Name:OLSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 NW QUIMBY ST APT 402
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-4090
Mailing Address - Country:US
Mailing Address - Phone:714-501-9459
Mailing Address - Fax:
Practice Address - Street 1:365 S REDWOOD ST
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-2405
Practice Address - Country:US
Practice Address - Phone:503-651-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-30
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR64710225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist