Jacob Anthony Olwell, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

7264 Issued in NC

Practice address

3001 Edwards Mill Rd
Raleigh, NC 27612-5243

Phone

(919) 781-4060

NPI assigned

Dec 3, 2024

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1733184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733184000000",
    "number": "1962228130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3001 EDWARDS MILL RD STE 200",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276125243",
            "telephone_number": "919-781-4060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3001 EDWARDS MILL RD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276125243",
            "telephone_number": "919-781-4060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLWELL",
        "first_name": "JACOB",
        "middle_name": "ANTHONY",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-12-03",
        "last_updated": "2024-12-03",
        "certification_date": "2024-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "VA",
            "license": "2306606052",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NC",
            "license": "7264",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eric Lee Olson, MD
• Eric Matthew Olson, MD
• Jean L Olson, LCSW BCD
• Lila Olson
• Lindsay Danielle Olson, MD
• Candice Givens Omar, LCSW
• Sakinah Omar
• Connie Yvette Omari, LPC
• Omega Healthcare Services, LLC
• Omega Independent Living Services

• Physical Therapy Assistant in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Physical Therapy Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.