Provider Demographics
NPI:1558245258
Name:MCNICKLE, PATRICK WAYNE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:WAYNE
Last Name:MCNICKLE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 S CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:MO
Mailing Address - Zip Code:64640-1285
Mailing Address - Country:US
Mailing Address - Phone:660-334-1742
Mailing Address - Fax:
Practice Address - Street 1:1 PROGRESS POINT PKWY STE 100
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-2212
Practice Address - Country:US
Practice Address - Phone:314-859-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist