Healthcare Provider Details

I. General information

NPI: 1194647362
Provider Name (Legal Business Name): DONOVAN D NELSON PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5606 SW LEE BLVD STE 101
LAWTON OK
73505-9615
US

IV. Provider business mailing address

373 SW BRADFORD LN
LAWTON OK
73505-5014
US

V. Phone/Fax

Practice location:
  • Phone: 580-531-4704
  • Fax: 580-531-4805
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number5449
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: