Provider Demographics
NPI:1144006123
Name:NELSON, WESTLEY S (LMT)
Entity type:Individual
Prefix:
First Name:WESTLEY
Middle Name:S
Last Name:NELSON
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 PEARL BONNETT RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:SC
Mailing Address - Zip Code:29856-2048
Mailing Address - Country:US
Mailing Address - Phone:834-670-2663
Mailing Address - Fax:
Practice Address - Street 1:310 PEARL BONNETT RD
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:SC
Practice Address - Zip Code:29856-2048
Practice Address - Country:US
Practice Address - Phone:843-670-2663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-05
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11127225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty