Provider Demographics
NPI:1326758673
Name:NELSON, MATTHEW CHASE (PTA)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:CHASE
Last Name:NELSON
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 1:805 EASTCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-5703
Mailing Address - Country:US
Mailing Address - Phone:972-841-0232
Mailing Address - Fax:
Practice Address - Street 1:1260 ABRAMS RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-4850
Practice Address - Country:US
Practice Address - Phone:214-515-1325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2144526225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant