Provider Demographics
NPI:1568046548
Name:NELSON, ERIN (DPT)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:KLEMM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3402 HOWLAND AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WI
Mailing Address - Zip Code:54476-5633
Mailing Address - Country:US
Mailing Address - Phone:715-355-5701
Mailing Address - Fax:
Practice Address - Street 1:3402 HOWLAND AVE STE 100
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WI
Practice Address - Zip Code:54476-5633
Practice Address - Country:US
Practice Address - Phone:715-355-5701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15079-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI15079-24Medicaid