Individual
KYLE R NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1621 COIT RD, PLANO, TX 75075-6141
(972) 596-7930
Mailing address
808 RIVER ROCK LN, ROCKWALL, TX 75032-6850
(972) 955-3089
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2140416
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1609397785
—
TX
Enumeration date
01/03/2019
Last updated
01/03/2019
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