Provider Demographics
NPI:1043726060
Name:NELSON, JOSEPH HARLAN (LMT)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:HARLAN
Last Name:NELSON
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1857 WOODDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-1510
Mailing Address - Country:US
Mailing Address - Phone:225-927-8160
Mailing Address - Fax:225-927-7751
Practice Address - Street 1:1857 WOODDALE BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-1510
Practice Address - Country:US
Practice Address - Phone:225-927-8160
Practice Address - Fax:225-927-7751
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-28
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA8586225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist