Dale S Nelson, PHYSICAL THERAPIST

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

025208 PT00002721 Issued in WA

Practice address

903 S Adams St
Ritzville, WA 99169-2227

Phone

(509) 659-1200

Fax

(509) 659-1252

NPI assigned

Oct 10, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403568000000",
    "number": "1508954249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "903 S ADAMS ST",
            "city": "RITZVILLE",
            "state": "WA",
            "postal_code": "991692227",
            "telephone_number": "509-659-1200",
            "fax_number": "509-659-1252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "903 S ADAMS ST",
            "city": "RITZVILLE",
            "state": "WA",
            "postal_code": "991692227",
            "telephone_number": "509-659-1200",
            "fax_number": "509-659-1252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "DALE",
        "middle_name": "S",
        "name_prefix": "Mr.",
        "credential": "PHYSICAL THERAPIST",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-10",
        "last_updated": "2014-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "025208 PT00002721",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L & I",
            "identifier": "92453",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FED WORKERS",
            "identifier": "603272500",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7105174",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dustin Killian, ATC, PTA
• Megan R Lane, DPT
• Traci Mattox, CNA
• Austin Mark Miner, CRNA
• Callie S Moore, RN
• NPD Services, LLC
• Brett Andrew Ott, LMT
• Lauren Elizabeth Phillips
• Mary Lee Phillips, A.P.R.N., F.N.P.
• Karen G Potts, RN

• Physical Therapist in Ritzville, WA
• Providers in Ritzville, WA by specialty
• Physical Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.