Provider Demographics
NPI:1992065841
Name:OLSEN, MICHELLE WARNER (MPT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:WARNER
Last Name:OLSEN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 W 1880 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-2119
Mailing Address - Country:US
Mailing Address - Phone:801-367-1865
Mailing Address - Fax:
Practice Address - Street 1:836 W 1880 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-2119
Practice Address - Country:US
Practice Address - Phone:801-367-1865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-25
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT362576-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist