Individual
ETHAN DANIEL NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1670 LEGACY PKWY E, MAPLEWOOD, MN 55109-5469
(651) 756-1859
Mailing address
1613 TAYLOR AVE W, SAINT PAUL, MN 55104-1241
(651) 354-6105
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A2889
MN
Other
Enumeration date
09/15/2023
Last updated
09/19/2023
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