Provider Demographics
NPI:1194989632
Name:NELSON, ERIC STEPHEN (LPTA)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:STEPHEN
Last Name:NELSON
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:ERIC
Other - Middle Name:STEPHEN
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPTA
Mailing Address - Street 1:1630 WORCESTER RD APT 412
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-5453
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1630 WORCESTER RD APT 412
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-5453
Practice Address - Country:US
Practice Address - Phone:508-872-0057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14226225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant