Provider Demographics
NPI:1710937149
Name:NELSON, KRISTAL KAY (PT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTAL
Middle Name:KAY
Last Name:NELSON
Suffix:
Gender:F
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 1492
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-1492
Mailing Address - Country:US
Mailing Address - Phone:919-557-3100
Mailing Address - Fax:919-557-3177
Practice Address - Street 1:100 FITNESS DR
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-7263
Practice Address - Country:US
Practice Address - Phone:919-557-3100
Practice Address - Fax:919-557-3177
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7450225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC078ETOtherBCBS
NC2503969Medicare ID - Type Unspecified