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NPI Code Detail

MEDICARE: DR. RHONDA NICHELLE NELSON PT, DPT, PCS

MEDICARE: DR. RHONDA NICHELLE NELSON PT, DPT, PCS
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
12251P0200XPediatric Physical Therapist22664CA

General Provider Information

NPI Number : 1134574031
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RHONDA NICHELLE NELSON PT, DPT, PCS
Provider Business Mailing Address
First Line : 10431 COMMERCE ST STE A
Second Line :
City : REDLANDS
State : CA
Zip : 92374-0110
Country : US
Telephone Number : 909-735-7654
Fax Number :
Provider Business Practice Location Address
First Line : 10431 COMMERCE ST STE A
Second Line :
City : REDLANDS
State : CA
Zip : 92374-0110
Country : US
Telephone Number : 909-735-7654
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2016
Last Update Date : 12/20/2021

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