Provider Demographics
NPI:1861792509
Name:OLSON, CARL (DPT)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:
Last Name:OLSON
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 1:5036 JERICHO TPKE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2812
Mailing Address - Country:US
Mailing Address - Phone:631-486-5286
Mailing Address - Fax:631-486-5287
Practice Address - Street 1:5036 JERICHO TPKE
Practice Address - Street 2:SUITE 301
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2812
Practice Address - Country:US
Practice Address - Phone:631-486-5286
Practice Address - Fax:631-486-5287
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032366225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist