Basic Information
| Provider Information | |||||||||
| NPI: | 1245553767 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NIELSEN | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1351 CORPORATE BLVD | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895027102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7758256450 | ||||||||
| FaxNumber: | 7758257680 | ||||||||
| Practice Location | |||||||||
| Address1: | 1351 CORPORATE BLVD | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895027102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7758256450 | ||||||||
| FaxNumber: | 7758257680 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2010 | ||||||||
| LastUpdateDate: | 10/12/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2378 | NV | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.