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General NPI Number Information
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NPI Number | 1285653840
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Entity Type | Individual
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Provider Name | JUDI G NELSON P.T.
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Gender | Female
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 03/23/2018
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Provider Practice Location Address
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Address Line | 76 COUNTRY CLUB LANE
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City | WILLOW CREEK
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State | CA
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Zip | 95573-1288
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Country | US
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Telephone | 707-599-6169
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Fax | 707-441-0777
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Provider Business Mailing Address
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Address Line | PO BOX 1288
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City | WILLOW CREEK
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State | CA
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Zip | 95573-1288
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Country | US
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Telephone | 707-441-0770
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Fax | 707-441-0777
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 20775
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License Number State | CA
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