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NPI Code Detail

MEDICARE: KELLY NELSON PTA

MEDICARE: KELLY NELSON PTA
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
1225200000XPhysical Therapy Assistant1401554KS

General Provider Information

NPI Number : 1548462666
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY NELSON PTA
Provider Business Mailing Address
First Line : 915 215TH ST
Second Line :
City : FORT SCOTT
State : KS
Zip : 66701-8734
Country : US
Telephone Number : 620-223-5349
Fax Number :
Provider Business Practice Location Address
First Line : 915 HORTON ST
Second Line :
City : FORT SCOTT
State : KS
Zip : 66701-2437
Country : US
Telephone Number : 615-896-6400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2007
Last Update Date : 07/08/2007

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Directions to “ KELLY NELSON PTA” Practice Location

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