Provider Demographics
NPI:1568601417
Name:NOLAN, EARL DAVIS (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:EARL
Middle Name:DAVIS
Last Name:NOLAN
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5621 INDIAN TRCE
Mailing Address - Street 2:
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-3412
Mailing Address - Country:US
Mailing Address - Phone:573-225-1791
Mailing Address - Fax:
Practice Address - Street 1:5621 INDIAN TRCE
Practice Address - Street 2:
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-3412
Practice Address - Country:US
Practice Address - Phone:573-225-1791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005019642225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist