Provider Demographics
NPI:1417033309
Name:NELSON, AMELIA (PT)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:
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 1:23 HAWK LN
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2070
Mailing Address - Country:US
Mailing Address - Phone:856-596-1761
Mailing Address - Fax:856-424-8632
Practice Address - Street 1:1869 GREENTREE RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2009
Practice Address - Country:US
Practice Address - Phone:856-424-2444
Practice Address - Fax:856-424-8632
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00242000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ900053517OtherTAX IDENTIFICATION NUMBER
NJ504105Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER