Elly Nelson, PT
Individual provider Active NPI Physical Therapist · Mounds, IL
NPI 1932140720 · NPPES record last updated Jul 13, 2026
Key facts
- NPI
- 1932140720
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- Practice address
- 429 S Blanche St
Mounds, IL 62964-1107 - Phone
- (618) 745-9419
- Fax
- (618) 745-9421
- NPI assigned
- Jun 10, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
426 S Blanche St
Mounds, IL 62964-1108
Phone (618) 745-9419
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040927000087 | IL | Practitioner - Physical Therapist in Private Practice | 7618946898 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070-013993 | IL | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Diversified Rehab Services, LLC | Physical Therapist | Current |
Accepting new patients |
Locations
426 S Blanche St
Mounds, IL 62964
Phone (618) 745-6894
429 S Blanche St
Ste 210
Mounds, IL 62964
Phone (618) 745-9419
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | IL | Yes |
Addresses
Primary practice location
429 S Blanche St
Mounds, IL 62964-1107
Mailing address
429 S Blanche St
Mounds, IL 62964-1107
Phone (618) 745-9419
Other providers in Mounds, IL
- Dixon Chiropractic Center, PC
- Dewey G Dixon Jr.
- Gordon D Holden
- Integrated Family Health LLC
- Meridian Cusd #101
All providers in Mounds, IL · Physical Therapist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.