Provider Demographics
NPI:1528729514
Name:NELSON, CHRIS (PTA)
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:NELSON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1965 COLUMBIA PIKE APT 13
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-6171
Mailing Address - Country:US
Mailing Address - Phone:917-774-5641
Mailing Address - Fax:
Practice Address - Street 1:2445 ARMY NAVY DR STE 200
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22206-2988
Practice Address - Country:US
Practice Address - Phone:703-769-8442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-03
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012961225200000X
VA2306606527225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant