Organization
KAY NIELSON PTA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KAY MARIE NIELSON PTA/LMT (OWNER)
(541) 597-2273
Entity
Organization
Contact information
Practice address
18255 REDWOOD HWY, SELMA, OR 97538-9729
(541) 597-2273
(541) 597-2273
Mailing address
5050 LAKE SHORE DR, SELMA, OR 97538-9502
(541) 597-2273
(541) 597-2273
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
7578
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7202
MASSAGE BOARD
OR
01
—
7578
PT BOARD
OR
Enumeration date
09/15/2006
Last updated
08/22/2020
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