| Doctor Name: | NICOLE MATTINGLY |
| NPI Number: | 1538571104 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 2010006700 |
| Business Practice Address: | 1640 Redstone Ctr Dr Park City, UT - 840987605 |
| Business Phone Number: | 4357767222 |
| Business Fax Number: | |
| Mailing Address: | 5 Patriot Pt, ARNOLD |
| State: | MO |
| Postal Code: | 630101874 |
| Phone Number: | 3147048723 |
| Fax Number: | |
| NPI Enumeration Date: | 05/29/2014 |
| NPI Last Update Date: | 05/29/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 2010006700 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |