Provider Demographics
NPI:1043229362
Name:DIAZ-OLSON PHYSICAL THERAPY AND SPORTS REHABILITATION, INC.
Entity type:Organization
Organization Name:DIAZ-OLSON PHYSICAL THERAPY AND SPORTS REHABILITATION, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:NEAL
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:408-245-3575
Mailing Address - Street 1:452 E EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-1938
Mailing Address - Country:US
Mailing Address - Phone:408-245-3575
Mailing Address - Fax:408-245-3576
Practice Address - Street 1:448 E EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087
Practice Address - Country:US
Practice Address - Phone:408-245-3575
Practice Address - Fax:408-245-3576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ30166ZMedicare ID - Type UnspecifiedMEDICARE ID NUMBER