Healthcare Provider Details

I. General information

NPI: 1871091983
Provider Name (Legal Business Name): NICOLE MAY PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2018
Last Update Date: 01/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S KIRKWOOD RD STE 150
SAINT LOUIS MO
63122-7251
US

IV. Provider business mailing address

1474 KENTBROOKE DR
BALLWIN MO
63021-7565
US

V. Phone/Fax

Practice location:
  • Phone: 314-821-7554
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2017024879
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: