MEDICARE: NATASJA NELSON DPT

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
1	225100000X	Physical Therapist	19575	MA

General Provider Information

NPI Number	:	1043594153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATASJA NELSON DPT

Provider Business Mailing Address
First Line	:	3639 MIDWAY DR
Second Line	:	STE B286
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-5254
Country	:	US
Telephone Number	:	858-488-3597
Fax Number	:	858-724-1747

Provider Business Practice Location Address
First Line	:	501 W BROADWAY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-3536
Country	:	US
Telephone Number	:	858-488-3597
Fax Number	:	858-724-1747

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2011
Last Update Date	:	06/03/2015

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