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General NPI Number Information
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NPI Number | 1679903157
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Entity Type | Individual
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Provider Name | PAUL NELSON PTA/L
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Gender | Male
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Dates
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Enumeration Date | 11/19/2013
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Last Update Date | 11/19/2013
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Provider Practice Location Address
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Address Line | 11 DAIRY LANE
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City | FREDERICKSBURG
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State | VA
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Zip | 22554
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Country | US
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Telephone | 860-748-2108
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Fax |
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Provider Business Mailing Address
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Address Line | 102 LAKESEDGE LN APT. 104
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City | STAFFORD
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State | VA
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Zip | 22554-7509
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Country | US
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Telephone | 860-748-2108
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2306603748
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 000346
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 3385
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 0576
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License Number State | NH
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