Provider Demographics
NPI:1992952337
Name:NELSON, JENNIFER KALASKY (PT, GCS)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:KALASKY
Last Name:NELSON
Suffix:
Gender:F
Credentials:PT, GCS
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LEE
Other - Last Name:KALASKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:556 ROCKY MOUTH LN
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-7616
Mailing Address - Country:US
Mailing Address - Phone:801-831-6459
Mailing Address - Fax:
Practice Address - Street 1:4600 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-5108
Practice Address - Country:US
Practice Address - Phone:801-272-1892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT120379-24012251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics