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NPI Code Detail

MEDICARE: ERIC H NELSON P.T.

MEDICARE: ERIC H 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 TherapistPT9978CA

General Provider Information

NPI Number : 1760577449
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIC H NELSON P.T.
Provider Business Mailing Address
First Line : 528 CROWN HILL ST
Second Line :
City : ARROYO GRANDE
State : CA
Zip : 93420-2815
Country : US
Telephone Number : 805-543-5633
Fax Number : 805-543-5990
Provider Business Practice Location Address
First Line : 1545 HIGUERA ST
Second Line :
City : SAN LUIS OBISPO
State : CA
Zip : 93401-2917
Country : US
Telephone Number : 805-543-5633
Fax Number : 805-543-5990
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2006
Last Update Date : 08/15/2012

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