Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT 32087 | FL |
Y | 2251S0007X | Physical Therapist - Sports | PT 32087 | FL |
NPI | 1437692571 |
---|---|
Provider Name | Andreas Olesen |
First Address | Miami Beach, FL 33139-8659 |
Second Address | Miami, FL 33150-3550 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2016 |
Last Update Date | 21/11/2016 |