Individual
MRS. NICOLE WOMACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MPT
Contact information
Practice address
1554 CALIFORNIA AVE, SAINT LOUIS, MO 63104-2048
(314) 496-2502
(314) 771-8728
Mailing address
PO BOX 19156, SAINT LOUIS, MO 63118-9156
(314) 496-2502
(314) 771-8728
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2006006006
MO
Other
Enumeration date
12/03/2013
Last updated
12/03/2013
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