Healthcare Provider Details

I. General information

NPI: 1942600994
Provider Name (Legal Business Name): RYAN NESLUND PT, DPT, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2014
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16838 E PALISADES BLVD BLDG B-121
FOUNTAIN HILLS AZ
85268-3786
US

IV. Provider business mailing address

9097 E DESERT COVE AVE SUITE 110
SCOTTSDALE AZ
85260-6279
US

V. Phone/Fax

Practice location:
  • Phone: 480-837-2595
  • Fax: 480-837-2773
Mailing address:
  • Phone: 480-551-4961
  • Fax: 480-860-0165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: