Provider Demographics
NPI:1326064320
Name:NELSON, JANETTE F (PT)
Entity Type:Individual
Prefix:MS
First Name:JANETTE
Middle Name:F
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 1:552 S PASEO DOROTEA
Mailing Address - Street 2:STE 4
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92264-1437
Mailing Address - Country:US
Mailing Address - Phone:760-325-5950
Mailing Address - Fax:760-325-5945
Practice Address - Street 1:552 S PASEO DOROTEA
Practice Address - Street 2:STE 4
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92264-1437
Practice Address - Country:US
Practice Address - Phone:760-325-5950
Practice Address - Fax:760-325-5950
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT8791174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PT87911Medicare ID - Type UnspecifiedPT