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NPI Code Detail

MEDICARE: JACK ORRIN NELSON PT

MEDICARE: JACK ORRIN 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
1225100000XPhysical Therapist10344-024WI

General Provider Information

NPI Number : 1659545879
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACK ORRIN NELSON PT
Provider Business Mailing Address
First Line : 1600 COUNTY ROAD G
Second Line :
City : SPOONER
State : WI
Zip : 54801-8967
Country : US
Telephone Number : 715-635-9769
Fax Number :
Provider Business Practice Location Address
First Line : 19 W NEWTON ST
Second Line :
City : RICE LAKE
State : WI
Zip : 54868-1744
Country : US
Telephone Number : 715-234-2161
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2008
Last Update Date : 04/18/2008

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Directions to “ JACK ORRIN NELSON PT” Practice Location

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