Provider Demographics
NPI:1881861847
Name:NELSON, EMILY THERESA (MSPT)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:THERESA
Last Name:NELSON
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 THOMAS POINT RD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-3911
Mailing Address - Country:US
Mailing Address - Phone:207-442-0325
Mailing Address - Fax:
Practice Address - Street 1:14 THOMAS POINT RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-3911
Practice Address - Country:US
Practice Address - Phone:207-442-0325
Practice Address - Fax:207-443-4578
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2924225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME435071099Medicaid