Provider Demographics
NPI:1467602144
Name:NILSON, RHETT JARED (DPT)
Entity Type:Individual
Prefix:MR
First Name:RHETT
Middle Name:JARED
Last Name:NILSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5027 45TH ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-2974
Mailing Address - Country:US
Mailing Address - Phone:904-347-8054
Mailing Address - Fax:941-346-9646
Practice Address - Street 1:1076 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:OSPREY
Practice Address - State:FL
Practice Address - Zip Code:34229-9535
Practice Address - Country:US
Practice Address - Phone:941-918-9575
Practice Address - Fax:941-346-9646
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT24018225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist