MEDICARE: WENDY C NELSON PT

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	PTH2400	AL

General Provider Information

NPI Number	:	1285659821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY C NELSON PT

Provider Business Mailing Address
First Line	:	8823 PRODUCTION LN
Second Line	:
City	:	OOLTEWAH
State	:	TN
Zip	:	37363-6511
Country	:	US
Telephone Number	:	423-238-7217
Fax Number	:	423-238-3473

Provider Business Practice Location Address
First Line	:	2846 MOODY PKWY
Second Line	:	STE 200
City	:	MOODY
State	:	AL
Zip	:	35004-3328
Country	:	US
Telephone Number	:	205-640-4881
Fax Number	:	205-640-4882

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	12/18/2015

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