Provider Demographics
NPI:1699977140
Name:NELSON, ANDREW C (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:C
Last Name:NELSON
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-3944
Mailing Address - Country:US
Mailing Address - Phone:361-664-9675
Mailing Address - Fax:361-664-1100
Practice Address - Street 1:1302 E 5TH ST
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-3944
Practice Address - Country:US
Practice Address - Phone:361-664-9675
Practice Address - Fax:361-664-1100
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1427403-01Medicaid
TX8T7602OtherBLUE CROSS BLUE SHIELD
TX8J9262Medicare PIN