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NPI Code Detail

MEDICARE: POLLY MARIE NELSON P.T.

MEDICARE: POLLY MARIE NELSON P.T.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist9474NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1079N8OTHERNCBLUE CROSS OF NC

General Provider Information

NPI Number : 1245225432
Entity Type Code : Individual
Provider Name (Legal Business Name) : POLLY MARIE NELSON P.T.
Provider Business Mailing Address
First Line : 6808 CALI CT
Second Line :
City : GARNER
State : NC
Zip : 27529-7047
Country : US
Telephone Number : 919-803-6464
Fax Number :
Provider Business Practice Location Address
First Line : 3515 GLENWOOD AVE
Second Line :
City : RALEIGH
State : NC
Zip : 27612-4934
Country : US
Telephone Number : 919-863-6900
Fax Number : 919-863-6901
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2005
Last Update Date : 08/10/2009

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Directions to “ POLLY MARIE NELSON P.T.” Practice Location

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