Healthcare Provider Details

I. General information

NPI: 1033288360
Provider Name (Legal Business Name): COLLEEN NELSON PT, MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 IVY DR
NORTH NEWTON KS
67117-8001
US

IV. Provider business mailing address

2115 PEMBROKE AVE
NEWTON KS
67114-8748
US

V. Phone/Fax

Practice location:
  • Phone: 316-284-2900
  • Fax:
Mailing address:
  • Phone: 660-888-5476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070-010238
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: