Most Relevant Information
Provider Data
| NPI Number: | 1003639725 |
| Provider Name: | NICHOLAS LOUIS HENNICKE |
| Entity Type: | Individual |
| Taxonomy Code: | 225100000X |
| Specialty: | Physical Therapist |
| License Number: | 2012023539 |
Most Important Dates
| Enumeration Date: | 11/01/2024 |
| Last Updated: | 11/01/2024 |
Provider Practice Location
1880 CLARKSON RD
CHESTERFIELD
MO
630175000
Practice Location Phone/Fax
| Phone: | 6365363800 |
| Fax: |
Provider Mailing Location
7 CARNEGIE PLZ
CHERRY HILL
NJ
080031000
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |