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General NPI Number Information
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NPI Number | 1699048744
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Entity Type | Individual
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Provider Name | ASHLEY NICHOLE NELSON DPT, PT
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Gender | Female
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Dates
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Enumeration Date | 02/21/2012
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Last Update Date | 03/19/2012
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Provider Practice Location Address
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Address Line | 571 STANISLAUS AVE SUITE F
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City | ANGELS CAMP
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State | CA
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Zip | 95222-9354
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Country | US
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Telephone | 209-736-9056
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Fax | 209-736-9058
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Provider Business Mailing Address
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Address Line | PO BOX 637
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City | ANGELS CAMP
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State | CA
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Zip | 95221-0637
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Country | US
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Telephone | 209-736-9056
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Fax | 209-736-9058
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 38746
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License Number State | CA
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