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NPI Code Detail

MEDICARE: CHARLES NELSON PT

MEDICARE: CHARLES NELSON PT
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 Therapist40QA00119100NJ

General Provider Information

NPI Number : 1467651695
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES NELSON PT
Provider Business Mailing Address
First Line : 2222 SULLIVAN TRL
Second Line :
City : EASTON
State : PA
Zip : 18040-7958
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 200 BRISTOL GLEN DR
Second Line :
City : NEWTON
State : NJ
Zip : 07860-2329
Country : US
Telephone Number : 973-940-6310
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2007
Last Update Date : 07/17/2007

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