Individual
LYNN ANN NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
2601 FERRY ST, LAFAYETTE, IN 47904-3061
(765) 448-8000
(765) 448-8335
Mailing address
PO BOX 5545, LAFAYETTE, IN 47903-5545
(765) 448-8000
(765) 448-8335
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05002731A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000188968
ANTHEM PROVIDER NUMBER
IN
05
—
100099590
—
IN
01
—
9397845
PHCS PID NUMBER
IN
05
—
NE18586065
—
IN
Enumeration date
03/24/2006
Last updated
04/19/2010
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