Active NPI
Nicole Gundersen
- Neurology Physical Therapist
- Bridgeton, MO
National Provider Identifier
1972994309
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physical Therapist
- License
- 2011025926
- Practice address
- 12380 Depaul Drive
Bridgeton, MO 63044-2511 - Phone
- (314) 809-1860
- NPI assigned
- Feb 6, 2015
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Neurology Physical Therapist | 2251N0400X | 2011025926 | MO | Primary |
Addresses
Primary practice location
12380 Depaul Drive
Bridgeton, MO 63044-2511
Mailing address
1127 Childress Ave
Saint Louis, MO 63139-3303
Phone (314) 809-1860
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 |
|---|---|---|---|
| 2011025926 | MO | MD | Neurology Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1423180800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1423180800000",
"number": "1972994309",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1127 CHILDRESS AVE",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631393303",
"telephone_number": "314-809-1860"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12380 DEPAUL DRIVE",
"city": "BRIDGETON",
"state": "MO",
"postal_code": "630442511",
"telephone_number": "314-809-1860"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUNDERSEN",
"first_name": "NICOLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-02-06",
"last_updated": "2015-02-06",
"status": "A"
},
"taxonomies": [
{
"code": "2251N0400X",
"taxonomy_group": "",
"desc": "Physical Therapist, Neurology",
"state": "MO",
"license": "2011025926",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bridgeton, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.