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NPI Code Detail

MEDICARE: DR. NICOLE LYNN STOUT DPT, CLT-LANA

MEDICARE: DR. NICOLE LYNN STOUT DPT, CLT-LANA
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 TherapistPT012155LPA
2225100000XPhysical TherapistPT004223WV

General Provider Information

NPI Number : 1164424842
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NICOLE LYNN STOUT DPT, CLT-LANA
Provider Business Mailing Address
First Line : 943 MAPLE DR.
Second Line :
City : MORGANTOWN
State : WV
Zip : 26505-2812
Country : US
Telephone Number : 304-599-2515
Fax Number : 304-285-3738
Provider Business Practice Location Address
First Line : 943 MAPLE DR
Second Line :
City : MORGANTOWN
State : WV
Zip : 26505-2812
Country : US
Telephone Number : 304-599-2515
Fax Number : 304-285-3738
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2005
Last Update Date : 10/27/2025

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Directions to “ DR. NICOLE LYNN STOUT DPT, CLT-LANA” Practice Location

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