Provider Demographics
NPI:1376591198
Name:NELSON, NANCY ELIZABETH
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ELIZABETH
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 BEAR SWAMP RD
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:CT
Mailing Address - Zip Code:06232-1102
Mailing Address - Country:US
Mailing Address - Phone:860-742-1360
Mailing Address - Fax:
Practice Address - Street 1:178 HARTFORD RD
Practice Address - Street 2:#210
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-5986
Practice Address - Country:US
Practice Address - Phone:860-646-1561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1920225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist