Provider Demographics
NPI:1164147526
Name:NELSON, JOHN PEARCE (PT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PEARCE
Last Name:NELSON
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 1:2300 W MORTON ST STE 114
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-1671
Mailing Address - Country:US
Mailing Address - Phone:903-462-4085
Mailing Address - Fax:903-465-5533
Practice Address - Street 1:2300 W MORTON ST STE 114
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-1671
Practice Address - Country:US
Practice Address - Phone:903-462-4085
Practice Address - Fax:903-465-5533
Is Sole Proprietor?:No
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10480072251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics