Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | IA |
NPI | 1013498120 |
---|---|
Provider Name | Seth Olson |
First Address | West Burlington, IA 52655-1679 |
Second Address | West Burlington, IA 52655-1679 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2018 |
Last Update Date | 27/08/2018 |