Individual
MR. JEREMY LOUIS NELSON I
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
715 SOUTH WEBSTER AVE, GREEN BAY, WI 54301
(920) 431-5588
(920) 445-7090
Mailing address
744 SOUTH WEBSTER AVE, PO BOX 23400, GREEN BAY, WI 54305-3400
(920) 431-5588
(920) 445-7090
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
594-019
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36108600
—
WI
Enumeration date
05/08/2008
Last updated
05/08/2008
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