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JONATHAN RAY NELSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LPTA

Contact information

Practice address
1401 E STATE ST, ROCKFORD, IL 61104-2315
(779) 696-4595
Mailing address
193 BLACK STONE CT, SOUTH BELOIT, IL 61080-9238
(276) 239-2368

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160008600
IL

Other

Enumeration date
07/03/2019
Last updated
07/03/2019
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