Provider Demographics
NPI:1750673489
Name:NELSON, AMY J (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:J
Last Name:NELSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MRS
Other - First Name:AMY
Other - Middle Name:J
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:6802 S OLYMPIA AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74132-1826
Mailing Address - Country:US
Mailing Address - Phone:918-749-0762
Mailing Address - Fax:918-749-8531
Practice Address - Street 1:220 W 71ST ST # 2
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74132-2011
Practice Address - Country:US
Practice Address - Phone:918-749-0762
Practice Address - Fax:918-749-8531
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3872225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1750673489Medicaid
OK1750673489OtherPHYSICAL THERAPIST