Individual
NICOLE MATTINGLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1640 REDSTONE CTR DR, PARK CITY, UT 84098-7605
(435) 776-7222
Mailing address
5 PATRIOT PT, ARNOLD, MO 63010-1874
(314) 704-8723
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2010006700
MO
Other
Enumeration date
05/29/2014
Last updated
05/29/2014
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