Provider Demographics
NPI:1629568936
Name:NELSON, AIMEE J (LMT)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:J
Last Name:NELSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 SW BEAVERTON HILLSDALE HWY STE 465
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-4736
Mailing Address - Country:US
Mailing Address - Phone:971-207-6459
Mailing Address - Fax:
Practice Address - Street 1:10700 SW BEAVERTON HILLSDALE HWY STE 465
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005
Practice Address - Country:US
Practice Address - Phone:971-207-6459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-11
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR24134225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist