Provider Demographics
NPI:1932168259
Name:NELSON, ANDREW BRADLEY (ATC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:BRADLEY
Last Name:NELSON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2689 E 1470 S
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-9456
Mailing Address - Country:US
Mailing Address - Phone:801-798-8149
Mailing Address - Fax:
Practice Address - Street 1:800 W UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-5999
Practice Address - Country:US
Practice Address - Phone:801-863-8636
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer