Provider Demographics
NPI:1497341226
Name:NELSON, BRITTANY (PTA/LMT)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:PTA/LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 S CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-2020
Mailing Address - Country:US
Mailing Address - Phone:810-487-9733
Mailing Address - Fax:
Practice Address - Street 1:209 S CHERRY ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:MI
Practice Address - Zip Code:48433-2020
Practice Address - Country:US
Practice Address - Phone:810-487-9733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502006189225200000X
MI750101143225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant