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NPI Code Detail

MEDICARE: STEVEN NELSON

MEDICARE: STEVEN NELSON
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 AssistantPTA20556FL

General Provider Information

NPI Number : 1720603038
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEVEN NELSON
Provider Business Mailing Address
First Line : 3601 GAME FARM RD
Second Line :
City : PANAMA CITY
State : FL
Zip : 32404-3126
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3611 TRANSMITTER RD
Second Line :
City : PANAMA CITY
State : FL
Zip : 32404-9799
Country : US
Telephone Number : 850-747-9688
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2020
Last Update Date : 06/11/2020

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