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General NPI Number Information
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NPI Number | 1770514374
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Entity Type | Individual
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Provider Name | STEVEN WAYNE NELSON P.T.
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Gender | Male
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 01/18/2011
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Provider Practice Location Address
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Address Line | 3317 N WIMBERLY DR
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-4056
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Country | US
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Telephone | 479-587-3203
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Fax | 479-444-6942
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Provider Business Mailing Address
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Address Line | PO BOX 1608
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City | FAYETTEVILLE
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State | AR
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Zip | 72702-1608
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Country | US
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Telephone | 479-587-3203
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Fax | 479-444-6942
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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 | PT3317
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License Number State | AR
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