Provider Demographics
NPI:1235531260
Name:NELSON, RYAN A (DPT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:A
Last Name:NELSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8541 E ANDERSON DR
Mailing Address - Street 2:STE 100
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-5430
Mailing Address - Country:US
Mailing Address - Phone:480-585-6810
Mailing Address - Fax:480-585-6910
Practice Address - Street 1:30845 N CAVE CREEK RD
Practice Address - Street 2:STE 101
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331-2915
Practice Address - Country:US
Practice Address - Phone:480-342-9547
Practice Address - Fax:480-585-6910
Is Sole Proprietor?:No
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ10919225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist