Healthcare Provider Details

I. General information

NPI: 1588494488
Provider Name (Legal Business Name): NATHANIEL WINFIELD NELSON DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 WILKES RIDGE DR
RICHMOND VA
23233-7632
US

IV. Provider business mailing address

1821 MACTAVISH AVE APT 2409
RICHMOND VA
23230-4338
US

V. Phone/Fax

Practice location:
  • Phone: 804-877-4000
  • Fax:
Mailing address:
  • Phone: 347-415-3891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP23309
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: