MEDICARE: MS. KATRINA DAWN 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	PT25843	FL

General Provider Information

NPI Number	:	1063789717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATRINA DAWN NELSON DPT

Provider Business Mailing Address
First Line	:	11402 BUCHANAN LN
Second Line	:
City	:	SEFFNER
State	:	FL
Zip	:	33584-4302
Country	:	US
Telephone Number	:	352-210-0712
Fax Number	:

Provider Business Practice Location Address
First Line	:	3500 E FLETCHER AVE STE 110
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33613-4789
Country	:	US
Telephone Number	:	813-977-7671
Fax Number	:

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

Provider Enumeration Date	:	11/23/2011
Last Update Date	:	11/23/2011

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