Active NPI
Steven Nicholson
- Physical Therapist
- Osage Beach, MO
National Provider Identifier
1174649032
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2005009930
- Practice address
- 54 Hospital Dr
Physical Therapy Dept.
Osage Beach, MO 65065-3050 - Phone
- (573) 302-2330
- NPI assigned
- Mar 22, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2005009930 | MO | Primary |
Addresses
Primary practice location
54 Hospital Dr
Physical Therapy Dept.
Osage Beach, MO 65065-3050
Mailing address
20314 Timberlake Village
Unit 641
Rocky Mount, MO 65072
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2005009930 | MO | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1174649032",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20314 TIMBERLAKE VILLAGE",
"address_2": "UNIT 641",
"city": "ROCKY MOUNT",
"state": "MO",
"postal_code": "65072"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "54 HOSPITAL DR",
"address_2": "PHYSICAL THERAPY DEPT.",
"city": "OSAGE BEACH",
"state": "MO",
"postal_code": "650653050",
"telephone_number": "573-302-2330"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLSON",
"first_name": "STEVEN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MO",
"license": "2005009930",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Osage Beach, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.