Individual
MS. COLLEEN NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, MPT
Contact information
Practice address
3001 IVY DR, NORTH NEWTON, KS 67117-8001
(316) 284-2900
Mailing address
2115 PEMBROKE AVE, NEWTON, KS 67114-8748
(660) 888-5476
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070-010238
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070-010238
PROFESSIONAL LICENSE
IL
01
—
2010024531
STATE LICENSE
MO
Enumeration date
11/08/2006
Last updated
08/17/2021
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