Provider Demographics
NPI:1083661755
Name:NELIPOVICH, NICK (PT)
Entity Type:Individual
Prefix:MR
First Name:NICK
Middle Name:
Last Name:NELIPOVICH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 N BEDELL AVE
Mailing Address - Street 2:#B
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-8007
Mailing Address - Country:US
Mailing Address - Phone:830-774-1556
Mailing Address - Fax:830-774-6150
Practice Address - Street 1:2201 N BEDELL AVE
Practice Address - Street 2:#B
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-8007
Practice Address - Country:US
Practice Address - Phone:830-774-1556
Practice Address - Fax:830-774-6150
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1128148225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00221599OtherMEDICARE RAILROAD NUMBER
TX8T4024OtherBLUE CROSS ID NUMBER
TXP16751Medicare UPIN
TX8T4024OtherBLUE CROSS ID NUMBER