Provider Demographics
NPI:1760499362
Name:NELSON, GRANT H (DPT)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:H
Last Name:NELSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10560 LIGON MILL RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-6090
Mailing Address - Country:US
Mailing Address - Phone:919-556-4678
Mailing Address - Fax:919-556-4619
Practice Address - Street 1:10560 LIGON MILL RD
Practice Address - Street 2:SUITE 109
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-6090
Practice Address - Country:US
Practice Address - Phone:919-556-4678
Practice Address - Fax:919-556-4619
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10642225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC700929OtherACN
NC067X6OtherBCBS OF NC
NC2509172Medicare UPIN