Provider Demographics
NPI:1447595434
Name:NELSON, ALLISON CHICO (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:CHICO
Last Name:NELSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:ALLISON
Other - Middle Name:MARIE
Other - Last Name:CHICO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:5850 EL CAMINO REAL
Mailing Address - Street 2:100
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-8816
Mailing Address - Country:US
Mailing Address - Phone:760-804-1700
Mailing Address - Fax:
Practice Address - Street 1:5850 EL CAMINO REAL
Practice Address - Street 2:100
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-8816
Practice Address - Country:US
Practice Address - Phone:760-804-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-03
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38762225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGZ159ZMedicare PIN