Provider Demographics
NPI:1477578441
Name:NELSON, MATTHEW STEVEN (PT)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:STEVEN
Last Name:NELSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1265 E FORT UNION BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84047-1808
Mailing Address - Country:US
Mailing Address - Phone:801-849-0198
Mailing Address - Fax:801-849-0492
Practice Address - Street 1:1265 E FORT UNION BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84047-1808
Practice Address - Country:US
Practice Address - Phone:801-849-0198
Practice Address - Fax:801-849-0492
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2015-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9268225100000X
UT7138947-24012251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC811430Medicare PIN