Provider Demographics
NPI:1760738892
Name:NELSON, JENNIFER GRACE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:GRACE
Last Name:NELSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
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Mailing Address - Street 1:1290 MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WEBSTER
Mailing Address - State:SD
Mailing Address - Zip Code:57274-1119
Mailing Address - Country:US
Mailing Address - Phone:605-345-3710
Mailing Address - Fax:605-345-3905
Practice Address - Street 1:1290 NORTH MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:WEBSTER
Practice Address - State:SD
Practice Address - Zip Code:57274-0577
Practice Address - Country:US
Practice Address - Phone:605-345-3710
Practice Address - Fax:605-345-3905
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-26
Last Update Date:2013-10-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SD1656225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist