Provider Demographics
NPI:1841722915
Name:NEILSON, THAD R (CPO)
Entity type:Individual
Prefix:
First Name:THAD
Middle Name:R
Last Name:NEILSON
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2096 N 2350 E
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84040-8056
Mailing Address - Country:US
Mailing Address - Phone:801-821-3574
Mailing Address - Fax:801-392-0797
Practice Address - Street 1:1140 36TH ST
Practice Address - Street 2:STE 165
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-2050
Practice Address - Country:US
Practice Address - Phone:801-392-0075
Practice Address - Fax:801-392-0797
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management