Individual
KELLIE NIELSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
803 RUSSELL BLVD, DAVIS, CA 95616-3426
(530) 391-8670
Mailing address
3436 SACKETT LN, WINTERS, CA 95694-9687
(206) 518-1012
Taxonomy
Speciality
Code
Description
License number
State
2251N0400X
Neurology Physical Therapist
296763
CA
2251P0200X
Pediatric Physical Therapist
Primary
296763
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
296763
PHYSICAL THERAPY BOARD OF CALIFORNIA
CA
Enumeration date
07/22/2019
Last updated
07/22/2019
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