Individual
THEODORE BROOKE NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
5764 S FARM ROAD 203, ROGERSVILLE, MO 65742-6436
(417) 844-0223
(417) 864-5781
Mailing address
PO BOX 11031, SPRINGFIELD, MO 65808-1031
(417) 844-0223
(417) 864-5781
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
107405
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
431907333
TRICARE
MO
05
—
485344808
—
MO
01
—
P00196731
RAILROAD MEDICARE
MO
Enumeration date
06/02/2006
Last updated
08/20/2009
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