Individual
MR. FREDERICK NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4113 N 7TH AVE, PHOENIX, AZ 85013-3071
(602) 631-9698
Mailing address
5953 W AURORA DR, GLENDALE, AZ 85308-6357
(623) 670-4316
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT-00194P
AZ
Other
Enumeration date
07/13/2010
Last updated
07/13/2010
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