Kimberly Anne Nelson, PTA

Individual provider Active NPI Physical Therapy Assistant · Newalla, OK

NPI 1275838773 · NPPES record last updated Jan 14, 2011

Key facts

NPI
1275838773
Entity type
Individual (NPI type 1)
Primary specialty
Physical Therapy Assistant 225200000X
License
831 (OK)
Practice address
5800 Sun Perch Dr
Newalla, OK 74857-6432
Phone
(405) 659-0606
Fax
(877) 866-5803
NPI assigned
Jan 14, 2011
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
831OKMDPhysical Therapy Assistant
2080350TXMDPhysical Therapy Assistant

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X 831 OK Yes
Physical Therapy Assistant 225200000X 2080350 TX

Addresses

Primary practice location

5800 Sun Perch Dr
Newalla, OK 74857-6432

Mailing address

5800 Sun Perch Dr
Newalla, OK 74857-6432
Phone (405) 659-0606

Other providers in Newalla, OK

All providers in Newalla, OK · Physical Therapy Assistant in Oklahoma

Sources for this page

Verify at the official NPI Registry.