Provider Demographics
NPI:1053960468
Name:OLSEN, ANDREA LYNN (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:LYNN
Last Name:OLSEN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:649 13TH ST
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-8618
Mailing Address - Country:US
Mailing Address - Phone:609-402-7756
Mailing Address - Fax:
Practice Address - Street 1:314 CENTRAL AVE STE 2A
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-2005
Practice Address - Country:US
Practice Address - Phone:609-365-8499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01885500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty