Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 043866-1 | NY |
NPI | 1043781503 |
---|---|
Provider Name | Justin Patrick Nelson |
First Address | Amherst, NY 14226 |
Second Address | Amherst, NY 14226 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2018 |
Last Update Date | 10/12/2018 |