Provider Demographics
NPI:1003118886
Name:AMELIA NELSON BS PT LLC
Entity Type:Organization
Organization Name:AMELIA NELSON BS PT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:BS, PT, CCTT
Authorized Official - Phone:856-424-2444
Mailing Address - Street 1:1869 GREENTREE RD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2009
Mailing Address - Country:US
Mailing Address - Phone:856-424-2444
Mailing Address - Fax:856-424-8632
Practice Address - Street 1:1869 GREENTREE RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2009
Practice Address - Country:US
Practice Address - Phone:856-424-2444
Practice Address - Fax:856-424-8632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-29
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00242000261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ545105OtherMEDICARE PROVIDER NUMBER
NJ1417033309OtherINDIVIDUAL NPI