Provider Demographics
NPI:1659309110
Name:NELSON, JOSEPHA ELEANOR (DPT)
Entity Type:Individual
Prefix:MRS
First Name:JOSEPHA
Middle Name:ELEANOR
Last Name:NELSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 PENINSULA RD
Mailing Address - Street 2:
Mailing Address - City:MEDICINE LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55441-4179
Mailing Address - Country:US
Mailing Address - Phone:763-540-6884
Mailing Address - Fax:
Practice Address - Street 1:700 TWELVE OAKS CENTER DR
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-4401
Practice Address - Country:US
Practice Address - Phone:952-476-0224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7288225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist