Provider Demographics
NPI:1407330533
Name:NELSON, ALISON KAY (DPT)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:KAY
Last Name:NELSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:KAY
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2125 E HENNEPIN AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-0001
Mailing Address - Country:US
Mailing Address - Phone:612-750-7168
Mailing Address - Fax:612-564-7373
Practice Address - Street 1:2125 E HENNEPIN AVE STE 300
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-0001
Practice Address - Country:US
Practice Address - Phone:612-750-7168
Practice Address - Fax:612-564-7373
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11348225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH400519679Medicaid