Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT21545 | CA |
N | 2251X0800X | Physical Therapist - Orthopedic | PT21545 | CA |
NPI | 1023183464 |
---|---|
Provider Name | Mr. Donald Eric Nelson JR. |
First Address | Los Angeles, CA 90048-4107 |
Second Address | Los Angeles, CA 90048-4107 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 09/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P10976 | (02) | CA |