Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251G0304X | Physical Therapist - Geriatrics | 61681 | OR |
Y | 2251N0400X | Physical Therapist - Neurology | 61681 | OR |
NPI | 1134608144 |
---|---|
Provider Name | Michael Nelson |
First Address | Medford, OR 97504-3633 |
Second Address | Medford, OR 97504-6241 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2018 |
Last Update Date | 09/08/2018 |