Provider Demographics
NPI:1649019910
Name:NELSON, CAMERON BRYCE (PT, DPT, CBIS)
Entity type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:BRYCE
Last Name:NELSON
Suffix:
Gender:M
Credentials:PT, DPT, CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5049 W ROCK BUTTE
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096-7779
Mailing Address - Country:US
Mailing Address - Phone:509-554-2140
Mailing Address - Fax:
Practice Address - Street 1:13747 S REDWOOD RD
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-5710
Practice Address - Country:US
Practice Address - Phone:801-417-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist