Individual
MICHAEL NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
1111 CRATER LAKE AVE, MEDFORD, OR 97504-6241
(541) 732-1111
Mailing address
3073 RUBY DR, MEDFORD, OR 97504-3633
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
61681
OR
2251N0400X
Neurology Physical Therapist
Primary
61681
OR
Other
Enumeration date
08/09/2018
Last updated
08/09/2018
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