Provider Demographics
NPI:1124262100
Name:NELSON, MELINDA MARIE (PTA)
Entity type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:MARIE
Last Name:NELSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ZUMBROTA
Mailing Address - State:MN
Mailing Address - Zip Code:55992-1530
Mailing Address - Country:US
Mailing Address - Phone:507-208-6407
Mailing Address - Fax:479-201-0280
Practice Address - Street 1:664 E 4TH ST
Practice Address - Street 2:
Practice Address - City:ZUMBROTA
Practice Address - State:MN
Practice Address - Zip Code:55992-1530
Practice Address - Country:US
Practice Address - Phone:507-208-6407
Practice Address - Fax:479-201-0280
Is Sole Proprietor?:No
Enumeration Date:2009-04-22
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA322225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant