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NPI Code Detail

MEDICARE: LEEANN NELSON PT

MEDICARE:   LEEANN  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 Therapist17180MD

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
7650026081OTHERMDRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12888094OTHERMDAETNA HMO
2010677886TAOTHERMDPERFERRED HEALTH NETWORK
34586282OTHERMDAETNA PPO
454544506OTHERMDCAREFIRST BCBS
5611528200OTHERMDUS DEPT OF LABOR
6H523410OTHERMDUNITED HEALTH CARE
8S435001OTHERMDCAREFIRST BLUE CHOICE

General Provider Information

NPI Number : 1942347901
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEEANN NELSON PT
Provider Business Mailing Address
First Line : 410 MALONEY RD
Second Line :
City : ELKTON
State : MD
Zip : 21921-6337
Country : US
Telephone Number : 410-392-9400
Fax Number : 410-392-0577
Provider Business Practice Location Address
First Line : 410 MALONEY RD
Second Line :
City : ELKTON
State : MD
Zip : 21921-6337
Country : US
Telephone Number : 410-392-9400
Fax Number : 410-392-0577
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2007
Last Update Date : 06/20/2019

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