Provider Demographics
NPI:1780752063
Name:NELSON, GRETCHEN R (MPT)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:R
Last Name:NELSON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:R
Other - Last Name:WINTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:4040 ORCHARD ST W
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FIRCREST
Mailing Address - State:WA
Mailing Address - Zip Code:98466-6606
Mailing Address - Country:US
Mailing Address - Phone:253-564-1560
Mailing Address - Fax:253-564-4449
Practice Address - Street 1:7308 BRIDGEPORT WAY W
Practice Address - Street 2:SUITE 103
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-8000
Practice Address - Country:US
Practice Address - Phone:253-582-8142
Practice Address - Fax:253-582-8160
Is Sole Proprietor?:No
Enumeration Date:2006-12-02
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 33249225100000X
WAPT60077726225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist