MEDICARE: MR. RICHARD NICHOLAS HUELSING RPT

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
1	225100000X	Physical Therapist	00911	MO

General Provider Information

NPI Number	:	1225075831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD NICHOLAS HUELSING RPT

Provider Business Mailing Address
First Line	:	4510 SUNHILL DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-2452
Country	:	US
Telephone Number	:	314-487-4202
Fax Number	:

Provider Business Practice Location Address
First Line	:	11960 WESTLINE INDUSTRIAL DR STE 201
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-3209
Country	:	US
Telephone Number	:	866-433-9555
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	01/17/2012

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