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General NPI Number Information
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NPI Number | 1396989927
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Entity Type | Organization
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Legal Business Name | LEE ANN NELSON PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 04/27/2009
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Last Update Date | 04/27/2009
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Provider Practice Location Address
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Address Line | 4899 PULASKI HIGHWAY SUITE A
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City | PERRYVILLE
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State | MD
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Zip | 21903
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Country | US
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Telephone | 410-392-9400
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Fax | 410-392-0577
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Provider Business Mailing Address
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Address Line | 4899 PULASKI HIGHWAY SUITE A
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City | PERRYVILLE
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State | MD
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Zip | 21903
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Country | US
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Telephone | 410-392-9400
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Fax | 410-392-0577
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | LEE ANN NELSON
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Credential | PT
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Telephone | 410-392-9400
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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 | 17180
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License Number State | MD
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