Provider Demographics
NPI:1568454858
Name:NELSON, DAVID E (PT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:NELSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 933
Mailing Address - Street 2:
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-0933
Mailing Address - Country:US
Mailing Address - Phone:435-613-1500
Mailing Address - Fax:435-613-1501
Practice Address - Street 1:590 E 100 N
Practice Address - Street 2:SUITE 1
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-2640
Practice Address - Country:US
Practice Address - Phone:435-613-1500
Practice Address - Fax:435-613-1501
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT284999-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT52871203001Medicaid
UT52871203001Medicaid
UT005581103Medicare ID - Type Unspecified