Basic Information
| Provider Information | |||||||||
| NPI: | 1861474538 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NELSON | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | RPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 305 N WATER ST | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366024011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514315818 | ||||||||
| FaxNumber: | 2514315810 | ||||||||
| Practice Location | |||||||||
| Address1: | 305 N WATER ST | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366024011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514315818 | ||||||||
| FaxNumber: | 2514315810 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2005 | ||||||||
| LastUpdateDate: | 07/29/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PTH1919 | AL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 510-98076 | 01 | AL | BC/BS PROVIDER # | OTHER |