Provider Demographics
NPI:1164187951
Name:NOLD, RAYMOND SCOTT (PTA)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:SCOTT
Last Name:NOLD
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WILLA ST
Mailing Address - Street 2:
Mailing Address - City:SWEET SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:65351-1523
Mailing Address - Country:US
Mailing Address - Phone:660-815-4034
Mailing Address - Fax:
Practice Address - Street 1:202 S WEST ST
Practice Address - Street 2:
Practice Address - City:CONCORDIA
Practice Address - State:MO
Practice Address - Zip Code:64020-9643
Practice Address - Country:US
Practice Address - Phone:660-463-2267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011018348225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant