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NPI Code Detail

MEDICARE: ANDREA NELSON PTA

MEDICARE:   ANDREA  NELSON  PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant073793IA

General Provider Information

NPI Number : 1023407020
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA NELSON PTA
Provider Business Mailing Address
First Line : 135 WARNER ST
Second Line :
City : ROCKWELL CITY
State : IA
Zip : 50579-1722
Country : US
Telephone Number : 712-297-8918
Fax Number :
Provider Business Practice Location Address
First Line : 135 WARNER ST
Second Line :
City : ROCKWELL CITY
State : IA
Zip : 50579-1722
Country : US
Telephone Number : 712-297-8918
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/13/2015
Last Update Date : 01/13/2015

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