Individual
ANNA NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1818 N STATE ST, GREENFIELD, IN 46140-1086
(317) 462-1800
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(630) 296-2222
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05011818A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201315240
—
IN
01
—
M55585022
MEDICARE PTAN
IN
Enumeration date
08/18/2015
Last updated
12/14/2015
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