Provider Demographics
NPI:1679803019
Name:WILHELM-OLSEN, LISA MICHELLE (PT)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:MICHELLE
Last Name:WILHELM-OLSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:KY
Mailing Address - Zip Code:41071-1934
Mailing Address - Country:US
Mailing Address - Phone:513-262-1793
Mailing Address - Fax:
Practice Address - Street 1:3976 N HAMPTON DR
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-8443
Practice Address - Country:US
Practice Address - Phone:888-907-2667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-07
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH011765225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist