Provider Demographics
NPI:1053609891
Name:OLSEN, SHERRY WHITELEY (PT)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:WHITELEY
Last Name:OLSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:MARIE
Other - Last Name:POWERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:120 LAKESIDE AVE
Mailing Address - Street 2:STE 210
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-6534
Mailing Address - Country:US
Mailing Address - Phone:206-925-3762
Mailing Address - Fax:206-324-3600
Practice Address - Street 1:120 LAKESIDE AVE
Practice Address - Street 2:STE 210
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-6534
Practice Address - Country:US
Practice Address - Phone:206-925-3762
Practice Address - Fax:206-324-3600
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008495225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist