Provider Demographics
NPI:1447360680
Name:NICKS, DONNA (RPT)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:NICKS
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1848 BEM CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:OWENSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65066-3212
Mailing Address - Country:US
Mailing Address - Phone:573-832-2288
Mailing Address - Fax:
Practice Address - Street 1:1848 BEM CHURCH RD
Practice Address - Street 2:
Practice Address - City:OWENSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65066-3212
Practice Address - Country:US
Practice Address - Phone:573-832-2288
Practice Address - Fax:573-832-2288
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01264225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist