Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 2021006184 | MO |
NPI | 1013501303 |
---|---|
Provider Name | Nicole Hale |
First Address | Grain Valley, MO 64029-9111 |
Second Address | Lees Summit, MO 64082-4618 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2021 |
Last Update Date | 26/02/2021 |