Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 30753 | AZ |
N | 2251E1200X | Ergonomics | 30753 | AZ |
N | 225XE1200X | Ergonomics | 30753 | AZ |
N | 2251G0304X | Physical Therapist - Geriatrics | 30753 | AZ |
N | 2251S0007X | Physical Therapist - Sports | 30753 | AZ |
Y | 2251X0800X | Physical Therapist - Orthopedic | 30753 | AZ |
NPI | 1265085476 |
---|---|
Provider Name | David Nelson |
First Address | Phoenix, AZ 85040-8862 |
Second Address | Avondale, AZ 85392-4879 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2019 |
Last Update Date | 17/07/2019 |