Provider Demographics
NPI:1023450822
Name:NICOLAI, BRENDA J (PT, MHS, OCS)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:J
Last Name:NICOLAI
Suffix:
Gender:F
Credentials:PT, MHS, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 S KINGSHIGHWAY ST
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-5919
Mailing Address - Country:US
Mailing Address - Phone:573-887-3200
Mailing Address - Fax:573-887-2400
Practice Address - Street 1:806 S KINGSHIGHWAY ST
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-5919
Practice Address - Country:US
Practice Address - Phone:573-887-3200
Practice Address - Fax:573-887-2400
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00438225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist