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General NPI Number Information
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NPI Number | 1609164359
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Entity Type | Individual
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Provider Name | NICOLE DESIREE NELSON-KRETZ PT, DPT, CMPT
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Gender | Female
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Dates
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Enumeration Date | 07/15/2011
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Last Update Date | 05/12/2016
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Provider Practice Location Address
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Address Line | 210 N UNIVERSITY DR.
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City | CORAL SPRINGS
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State | FL
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Zip | 33072-7721
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Country | US
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Telephone | 954-344-5220
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Fax |
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Provider Business Mailing Address
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Address Line | 5091 SW BIMINI CIRCLE N
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City | PALM CITY
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State | FL
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Zip | 34990-1615
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 26605
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License Number State | FL
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