Provider Demographics
NPI:1396989927
Name:LEE ANN NELSON PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:LEE ANN NELSON PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LEE ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:410-392-9400
Mailing Address - Street 1:4899 PULASKI HIGHWAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:PERRYVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21903
Mailing Address - Country:US
Mailing Address - Phone:410-392-9400
Mailing Address - Fax:410-392-0577
Practice Address - Street 1:4899 PULASKI HIGHWAY
Practice Address - Street 2:SUITE A
Practice Address - City:PERRYVILLE
Practice Address - State:MD
Practice Address - Zip Code:21903
Practice Address - Country:US
Practice Address - Phone:410-392-9400
Practice Address - Fax:410-392-0577
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEE ANN NELSON PHYSICAL THERAPY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17180225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD430MMedicare PIN