Provider Demographics
NPI:1225692916
Name:NIELSEN, ASHLEY CHAD (PTA)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:CHAD
Last Name:NIELSEN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 W TREVI PL APT 163
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-7521
Mailing Address - Country:US
Mailing Address - Phone:402-750-0914
Mailing Address - Fax:
Practice Address - Street 1:3901 S MARION RD
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-1799
Practice Address - Country:US
Practice Address - Phone:605-361-3311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-28
Last Update Date:2019-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD293225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant