Healthcare Provider Details

I. General information

NPI: 1093403248
Provider Name (Legal Business Name): ROY GARRET NELSON JR. PT, DPT, OCS, SCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2023
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19711 STUEBNER AIRLINE RD STE 2
SPRING TX
77379-5448
US

IV. Provider business mailing address

19711 STUEBNER AIRLINE RD STE 2
SPRING TX
77379-5448
US

V. Phone/Fax

Practice location:
  • Phone: 701-430-3040
  • Fax:
Mailing address:
  • Phone: 701-430-3040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number1293900
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number1293900
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13012
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: