Provider Demographics
NPI:1285653840
Name:NELSON, JUDI G (PT)
Entity Type:Individual
Prefix:MRS
First Name:JUDI
Middle Name:G
Last Name:NELSON
Suffix:
Gender:F
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:PO BOX 1288
Mailing Address - Street 2:
Mailing Address - City:WILLOW CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:95573-1288
Mailing Address - Country:US
Mailing Address - Phone:707-441-0770
Mailing Address - Fax:707-441-0777
Practice Address - Street 1:76 COUNTRY CLUB LANE
Practice Address - Street 2:
Practice Address - City:WILLOW CREEK
Practice Address - State:CA
Practice Address - Zip Code:95573-1288
Practice Address - Country:US
Practice Address - Phone:707-599-6169
Practice Address - Fax:707-441-0777
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20775225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT207751Medicare ID - Type UnspecifiedMEDICARE