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General NPI Number Information
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NPI Number | 1194647362
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Entity Type | Individual
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Provider Name | DONOVAN D NELSON PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 07/28/2026
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Last Update Date | 07/28/2026
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Provider Practice Location Address
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Address Line | 5606 SW LEE BLVD STE 101
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City | LAWTON
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State | OK
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Zip | 73505-9615
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Country | US
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Telephone | 580-531-4704
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Fax | 580-531-4805
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Provider Business Mailing Address
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Address Line | 373 SW BRADFORD LN
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City | LAWTON
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State | OK
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Zip | 73505-5014
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 5449
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License Number State | OK
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