Provider Demographics
NPI:1952467987
Name:NELSON, PATRICIA (PT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
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 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:310 N RIVERPOINT BLVD
Practice Address - Street 2:BOX T ROOM 270
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1610
Practice Address - Country:US
Practice Address - Phone:509-828-1364
Practice Address - Fax:509-828-1389
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60045924225100000X
MN41472251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8925185Medicare PIN
AK160424Medicare ID - Type UnspecifiedMEDICARE#