Provider Demographics
NPI:1528304789
Name:NELSON, TELAN G (PT)
Entity type:Individual
Prefix:
First Name:TELAN
Middle Name:G
Last Name:NELSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TELAN
Other - Middle Name:JEAN
Other - Last Name:GREENLEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:705 GOLD LAKE DR STE 350
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-2558
Mailing Address - Country:US
Mailing Address - Phone:916-939-6800
Mailing Address - Fax:916-939-6874
Practice Address - Street 1:705 GOLD LAKE DR STE 350
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-2558
Practice Address - Country:US
Practice Address - Phone:916-939-6800
Practice Address - Fax:916-939-6874
Is Sole Proprietor?:No
Enumeration Date:2012-12-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT38927225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist