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NPI Code Detail

MEDICARE: JULIE C NIKKEL P.T.

MEDICARE: JULIE C NIKKEL P.T.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist2003020848MO

General Provider Information

NPI Number : 1629021340
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIE C NIKKEL P.T.
Provider Business Mailing Address
First Line : 2982 HIGHWAY K
Second Line :
City : O FALLON
State : MO
Zip : 63368-7861
Country : US
Telephone Number : 636-978-9235
Fax Number : 636-978-8299
Provider Business Practice Location Address
First Line : 2982 HIGHWAY K
Second Line :
City : O FALLON
State : MO
Zip : 63368-7861
Country : US
Telephone Number : 636-978-9235
Fax Number : 636-978-8299
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2006
Last Update Date : 07/08/2007

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