Provider Demographics
NPI:1689821530
Name:DRAKE, NANCY D (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:D
Last Name:DRAKE
Suffix:
Gender:F
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 1:55 KELLY RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MO
Mailing Address - Zip Code:65622-4139
Mailing Address - Country:US
Mailing Address - Phone:417-345-5210
Mailing Address - Fax:417-345-5210
Practice Address - Street 1:55 KELLY RD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MO
Practice Address - Zip Code:65622-4139
Practice Address - Country:US
Practice Address - Phone:417-345-5210
Practice Address - Fax:417-345-5210
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO02060225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist