Provider Demographics
NPI:1023183464
Name:NELSON, DONALD ERIC JR (PT)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:ERIC
Last Name:NELSON
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2309 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-2631
Mailing Address - Country:US
Mailing Address - Phone:323-697-4046
Mailing Address - Fax:323-655-9255
Practice Address - Street 1:8471 BEVERLY BLVD STE 208
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-3450
Practice Address - Country:US
Practice Address - Phone:323-655-9055
Practice Address - Fax:323-655-9255
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2024-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT215452251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP10976Medicare UPIN
CAWPT21545BMedicare ID - Type Unspecified