Healthcare Provider Details

I. General information

NPI: 1235653924
Provider Name (Legal Business Name): MATTHEW NELSON DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 08/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62222 FRANKFORT RD
SALESVILLE OH
43778-9638
US

IV. Provider business mailing address

501 OAKLAND BLVD
CAMBRIDGE OH
43725-2023
US

V. Phone/Fax

Practice location:
  • Phone: 740-679-2111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT017112
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: