Provider Demographics
NPI:1750758207
Name:NELSON, REBECCA D (DPT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:D
Last Name:NELSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 S POWER RD STE 123
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-6688
Mailing Address - Country:US
Mailing Address - Phone:480-218-1344
Mailing Address - Fax:480-218-1356
Practice Address - Street 1:2500 S POWER RD STE 123
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-6688
Practice Address - Country:US
Practice Address - Phone:480-218-1344
Practice Address - Fax:480-218-1356
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-31
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR61226225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist