Provider Demographics
NPI:1306942255
Name:NELSON, JEFFREY S (PT)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:S
Last Name:NELSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2322 CARRIAGE CIR
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-3604
Mailing Address - Country:US
Mailing Address - Phone:818-209-8888
Mailing Address - Fax:949-404-6914
Practice Address - Street 1:2322 CARRIAGE CIR
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-3604
Practice Address - Country:US
Practice Address - Phone:818-209-8888
Practice Address - Fax:949-404-6914
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29862225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA29862OtherLICENSE