Active NPI
Jack Orrin Nelson, PT
- Physical Therapist
- Rice Lake, WI
National Provider Identifier
1659545879
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 10344-024
- Practice address
- 19 W Newton St
Rice Lake, WI 54868-1744 - Phone
- (715) 234-2161
- NPI assigned
- Apr 18, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 10344-024 | WI | Primary |
Addresses
Primary practice location
19 W Newton St
Rice Lake, WI 54868-1744
Mailing address
1600 County Road G
Spooner, WI 54801-8967
Phone (715) 635-9769
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10344-024 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1208476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1208476800000",
"number": "1659545879",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1600 COUNTY ROAD G",
"city": "SPOONER",
"state": "WI",
"postal_code": "548018967",
"telephone_number": "715-635-9769"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19 W NEWTON ST",
"city": "RICE LAKE",
"state": "WI",
"postal_code": "548681744",
"telephone_number": "715-234-2161"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "JACK",
"middle_name": "ORRIN",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-04-18",
"last_updated": "2008-04-18",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "10344-024",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rice Lake, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.