Provider Demographics
NPI:1811186257
Name:NELSON, NANCY LANDERS (PT)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:LANDERS
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 1:236 W PORTAL AVE
Mailing Address - Street 2:#389
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94127-1423
Mailing Address - Country:US
Mailing Address - Phone:415-564-3604
Mailing Address - Fax:415-564-1853
Practice Address - Street 1:236 W PORTAL AVE
Practice Address - Street 2:#389
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94127-1423
Practice Address - Country:US
Practice Address - Phone:415-564-3604
Practice Address - Fax:415-564-1853
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2007-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14710225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist