Healthcare Provider Details

I. General information

NPI: 1023183464
Provider Name (Legal Business Name): DONALD ERIC NELSON JR. PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 01/27/2024
Certification Date: 01/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8471 BEVERLY BLVD STE 208
LOS ANGELES CA
90048-3450
US

IV. Provider business mailing address

2309 PACIFIC AVE
MANHATTAN BEACH CA
90266-2631
US

V. Phone/Fax

Practice location:
  • Phone: 323-655-9055
  • Fax: 323-655-9255
Mailing address:
  • Phone: 323-697-4046
  • Fax: 323-655-9255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT21545
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT21545
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: