Healthcare Provider Details

I. General information

NPI: 1518008408
Provider Name (Legal Business Name): ANDREW CHRISTOPHER NELSON PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 12/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 HIGHWAY 20
WINTHROP WA
98862
US

IV. Provider business mailing address

PO BOX 487
WINTHROP WA
98862-0487
US

V. Phone/Fax

Practice location:
  • Phone: 509-341-4011
  • Fax:
Mailing address:
  • Phone: 509-341-4011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT00003919
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: