Provider Demographics
NPI:1902098999
Name:OLSEN, BRAD RAYMOND (DPT)
Entity Type:Individual
Prefix:MR
First Name:BRAD
Middle Name:RAYMOND
Last Name:OLSEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 WEST ST
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-5911
Mailing Address - Country:US
Mailing Address - Phone:207-706-6076
Mailing Address - Fax:877-807-8994
Practice Address - Street 1:67 ATLANTIC HWY
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:ME
Practice Address - Zip Code:04849
Practice Address - Country:US
Practice Address - Phone:207-706-6076
Practice Address - Fax:877-807-8994
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT3210225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist