Provider Demographics
NPI:1699048744
Name:NELSON, ASHLEY NICHOLE (DPT, PT)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:NICHOLE
Last Name:NELSON
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:NICHOLE
Other - Last Name:FITZGERALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 637
Mailing Address - Street 2:
Mailing Address - City:ANGELS CAMP
Mailing Address - State:CA
Mailing Address - Zip Code:95221-0637
Mailing Address - Country:US
Mailing Address - Phone:209-736-9056
Mailing Address - Fax:209-736-9058
Practice Address - Street 1:571 STANISLAUS AVE
Practice Address - Street 2:SUITE F
Practice Address - City:ANGELS CAMP
Practice Address - State:CA
Practice Address - Zip Code:95222-9354
Practice Address - Country:US
Practice Address - Phone:209-736-9056
Practice Address - Fax:209-736-9058
Is Sole Proprietor?:No
Enumeration Date:2012-02-21
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38746174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist