Provider Demographics
NPI:1457567463
Name:NELSON, GEORGIA (PT)
Entity Type:Individual
Prefix:
First Name:GEORGIA
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 1:9223 BROADWAY ST
Mailing Address - Street 2:117
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-9758
Mailing Address - Country:US
Mailing Address - Phone:281-412-5549
Mailing Address - Fax:281-412-4155
Practice Address - Street 1:9223 BROADWAY ST
Practice Address - Street 2:117
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-9758
Practice Address - Country:US
Practice Address - Phone:281-412-5549
Practice Address - Fax:281-412-4155
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1150028225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L25268Medicare PIN