Provider Demographics
NPI:1093403248
Name:NELSON, ROY GARRET JR (PT, DPT, OCS, SCS)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:GARRET
Last Name:NELSON
Suffix:JR
Gender:M
Credentials:PT, DPT, OCS, SCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19711 STUEBNER AIRLINE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-5448
Mailing Address - Country:US
Mailing Address - Phone:701-430-3040
Mailing Address - Fax:
Practice Address - Street 1:19711 STUEBNER AIRLINE RD STE 2
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-5448
Practice Address - Country:US
Practice Address - Phone:701-430-3040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-26
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12939002251X0800X, 2251S0007X
MN13012225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty