Provider Demographics
NPI:1164037032
Name:EARLEY, NICHOLAS PATRICK (DPT)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:PATRICK
Last Name:EARLEY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 MEADOW CHASE DR
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-1575
Mailing Address - Country:US
Mailing Address - Phone:314-458-4442
Mailing Address - Fax:
Practice Address - Street 1:100 NE TUDOR RD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-4507
Practice Address - Country:US
Practice Address - Phone:816-554-6003
Practice Address - Fax:816-554-6013
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020029259225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist