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NPI Code Detail

MEDICARE: MRS. NICHOLE M HENDERSON P.T.

MEDICARE: MRS. NICHOLE M HENDERSON 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 Therapist2005040721MO

General Provider Information

NPI Number : 1255447025
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. NICHOLE M HENDERSON P.T.
Provider Business Mailing Address
First Line : 1840 ZUMBEHL RD
Second Line :
City : SAINT CHARLES
State : MO
Zip : 63303-2761
Country : US
Telephone Number : 636-947-7678
Fax Number : 636-947-4350
Provider Business Practice Location Address
First Line : 1840 ZUMBEHL RD
Second Line :
City : SAINT CHARLES
State : MO
Zip : 63303-2761
Country : US
Telephone Number : 636-947-7678
Fax Number : 636-947-4350
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2006
Last Update Date : 07/08/2007

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