Provider Demographics
NPI:1528169505
Name:NELSON, ERIC J (MSPT)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:J
Last Name:NELSON
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9174 N PLACITA SAN ANGEL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85742-1122
Mailing Address - Country:US
Mailing Address - Phone:520-369-0848
Mailing Address - Fax:
Practice Address - Street 1:9174 N PLACITA SAN ANGEL
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85742-1122
Practice Address - Country:US
Practice Address - Phone:520-369-0848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2015-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7956225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist