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General NPI Number Information
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NPI Number | 1326112988
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Entity Type | Individual
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Provider Name | NICOLE A AMOS PT
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Gender | Female
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 02/04/2020
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Provider Practice Location Address
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Address Line | 210 HARTMAN LN STE 500
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City | O FALLON
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State | IL
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Zip | 62269-1783
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Country | US
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Telephone | 618-589-9000
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Fax |
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Provider Business Mailing Address
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Address Line | 2609 LAUREN LAKE DR
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City | BELLEVILLE
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State | IL
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Zip | 62221-8620
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Country | US
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Telephone | 618-960-6407
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070.016637
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License Number State | IL
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