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NPI Code Detail

MEDICARE: MISS KELLEY NICOLE TATE P.T.

MEDICARE: MISS KELLEY NICOLE TATE 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 Therapist2002025550MO

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2650025700OTHERMOMEDICARE RAILROAD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3122566OTHERMOBCBS

General Provider Information

NPI Number : 1003811258
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS KELLEY NICOLE TATE P.T.
Provider Business Mailing Address
First Line : 4501 S HARVEST RD
Second Line :
City : COLUMBIA
State : MO
Zip : 65203-8764
Country : US
Telephone Number : 573-474-5098
Fax Number :
Provider Business Practice Location Address
First Line : 1420 W ASHLEY RD
Second Line :
City : BOONVILLE
State : MO
Zip : 65233-2112
Country : US
Telephone Number : 660-882-6115
Fax Number : 660-882-6120
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2005
Last Update Date : 02/20/2025

Similar Medicare Providers

1891790291 — MRS. JENNIFER JO HACKMAN P.T. ,A.T.C.
Practice Location Address:
1420 W ASHLEY RD
BOONVILLE, MO
65233-2112
Practice Phone: 660-882-6115
Practice Fax: 660-882-6120
1245340371 — MRS. ANDREA THERESA HOEHN MOT OTR/L
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Practice Fax:
1609930593 — EXCEL PHYSICAL THERAPY & SPORTS MEDICINE CLINIC
Practice Location Address:
1420 W ASHLEY RD
BOONVILLE, MO
65233-2112
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Practice Fax: 660-882-6120
1477672814 — JOHN LEE TATE PTA
Practice Location Address:
1420 W ASHLEY RD
BOONVILLE, MO
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Practice Fax:
1124264775 — SAMMY H GOEDRICH OTR
Practice Location Address:
1420 W ASHLEY RD
BOONVILLE, MO
65233-2112
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Practice Fax:
1134451313 — LINDSEY SCHEETS ATC
Practice Location Address:
1420 W ASHLEY RD
BOONVILLE, MO
65233-2112
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Practice Fax:

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