Healthcare Provider Details

I. General information

NPI: 1811882657
Provider Name (Legal Business Name): NICHOLAS ROCCO DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2025
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 HIGHWAY K
O FALLON MO
63366-2910
US

IV. Provider business mailing address

185 SANCTUARY DR
DARDENNE PRAIRIE MO
63368-8274
US

V. Phone/Fax

Practice location:
  • Phone: 636-240-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2025020314
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: