Provider Demographics
NPI:1215046966
Name:NICHOLAS, GREGORY PETER (MPT)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:PETER
Last Name:NICHOLAS
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Gender:M
Credentials:MPT
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Mailing Address - Street 1:4273 KEATON CROSSING BLVD
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-8220
Mailing Address - Country:US
Mailing Address - Phone:636-206-4225
Mailing Address - Fax:636-422-1051
Practice Address - Street 1:552 OLD SMIZER MILL RD
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026
Practice Address - Country:US
Practice Address - Phone:636-349-8060
Practice Address - Fax:636-349-9171
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2019-07-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2000173375225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist