Provider Demographics
NPI:1902154289
Name:NELSON, DREW DAVID (DPT)
Entity Type:Individual
Prefix:
First Name:DREW
Middle Name:DAVID
Last Name:NELSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:792 N MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:NORTH SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-1644
Mailing Address - Country:US
Mailing Address - Phone:315-458-2552
Mailing Address - Fax:315-458-2575
Practice Address - Street 1:140 W SENECA ST
Practice Address - Street 2:
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104-2420
Practice Address - Country:US
Practice Address - Phone:315-692-2336
Practice Address - Fax:315-692-2337
Is Sole Proprietor?:No
Enumeration Date:2012-08-17
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035344225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist