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General NPI Number Information
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NPI Number | 1346025442
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Entity Type | Individual
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Provider Name | BENJAMIN NOLTE
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Gender | Male
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Dates
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Enumeration Date | 08/28/2023
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Last Update Date | 08/28/2023
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Provider Practice Location Address
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Address Line | 1 JEFFERSON BARRACKS DR
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City | SAINT LOUIS
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State | MO
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Zip | 63125-4181
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Country | US
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Telephone | 314-906-2643
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Fax |
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Provider Business Mailing Address
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Address Line | 3109 FOX HILL RD
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City | SAINT CHARLES
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State | MO
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Zip | 63301-0008
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Country | US
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Telephone | 636-448-4731
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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 | 2022030024
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License Number State | MO
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