Individual
SUZANNE M NICKELS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
12509 VILLAGE CIRCLE DR, SAINT LOUIS, MO 63127-1701
(314) 270-7790
(314) 849-2045
Mailing address
723 SAINT JOSEPH RIDGE CT, SAINT LOUIS, MO 63129-7107
(314) 845-0332
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
116415
MO
Other
Enumeration date
07/10/2007
Last updated
07/10/2007
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