Individual
MISS NICHOLE DANIELLE GENTZSCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPTA
Contact information
Practice address
1195 CHOCTAW RIDGE DR, HOLTS SUMMIT, MO 65043-1488
(573) 353-2121
Mailing address
1195 CHOCTAW RIDGE DR, HOLTS SUMMIT, MO 65043-1488
(573) 353-2121
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2012038310
MO
Other
Enumeration date
07/30/2021
Last updated
07/30/2021
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