Provider Demographics
NPI:1942347901
Name:NELSON, LEEANN (PT)
Entity Type:Individual
Prefix:
First Name:LEEANN
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LEEANN
Other - Middle Name:
Other - Last Name:UPPERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:410 MALONEY RD
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-6337
Mailing Address - Country:US
Mailing Address - Phone:410-392-9400
Mailing Address - Fax:410-392-0577
Practice Address - Street 1:410 MALONEY RD
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-6337
Practice Address - Country:US
Practice Address - Phone:410-392-9400
Practice Address - Fax:410-392-0577
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17180225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2888094OtherAETNA HMO
MD010677886TAOtherPERFERRED HEALTH NETWORK
MD4586282OtherAETNA PPO
MD54544506OtherCAREFIRST BCBS
MD611528200OtherUS DEPT OF LABOR
MDH523410OtherUNITED HEALTH CARE
MD650026081OtherRAILROAD MEDICARE
MDS435001OtherCAREFIRST BLUE CHOICE
MD650026081OtherRAILROAD MEDICARE