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NPI Code Detail

MEDICARE: MR. HAROLD NELSON P.T.

MEDICARE: MR. HAROLD NELSON P.T.
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 TherapistPT7788CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PT7788OTHERCAPT LICENSE

General Provider Information

NPI Number : 1164479739
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. HAROLD NELSON P.T.
Provider Business Mailing Address
First Line : 12572 VALLEY VIEW ST
Second Line : ATTENTION JODY LANE
City : GARDEN GROVE
State : CA
Zip : 92845-2006
Country : US
Telephone Number : 714-823-4400
Fax Number : 714-823-4404
Provider Business Practice Location Address
First Line : 12572 VALLEY VIEW ST
Second Line : ATTENTION JODY LANE
City : GARDEN GROVE
State : CA
Zip : 92845-2006
Country : US
Telephone Number : 714-823-4400
Fax Number : 714-823-4404
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2006
Last Update Date : 03/30/2010

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