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NPI Code Detail

MEDICARE: MS. COLLEEN NELSON PT, MPT

MEDICARE: MS. COLLEEN NELSON PT, MPT
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
1225100000XPhysical Therapist070-010238IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1070-010238OTHERILPROFESSIONAL LICENSE
22010024531OTHERMOSTATE LICENSE

General Provider Information

NPI Number : 1033288360
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. COLLEEN NELSON PT, MPT
Provider Business Mailing Address
First Line : 2115 PEMBROKE AVE
Second Line :
City : NEWTON
State : KS
Zip : 67114-8748
Country : US
Telephone Number : 660-888-5476
Fax Number :
Provider Business Practice Location Address
First Line : 3001 IVY DR
Second Line :
City : NORTH NEWTON
State : KS
Zip : 67117-8001
Country : US
Telephone Number : 316-284-2900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2006
Last Update Date : 08/17/2021

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