Provider Demographics
NPI:1629941653
Name:NELSON, MICHELLE LYNN (PT, NCS, GCS)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:NELSON
Suffix:
Gender:F
Credentials:PT, NCS, GCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 HIGHLAND OAKS DR
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-3269
Mailing Address - Country:US
Mailing Address - Phone:214-591-0061
Mailing Address - Fax:
Practice Address - Street 1:1333 CORPORATE DR STE 245
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-7514
Practice Address - Country:US
Practice Address - Phone:214-591-0061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10595902251G0304X, 2251N0400X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology