Basic Information
| Provider Information | |||||||||
| NPI: | 1851400501 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DICKNEITE | ||||||||
| FirstName: | TODD | ||||||||
| MiddleName: | MARCUS | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4472 SADDLE MT | ||||||||
| Address2: | |||||||||
| City: | ST LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3148923937 | ||||||||
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| Practice Location | |||||||||
| Address1: | 376 FESTUS CENTER DRIVE | ||||||||
| Address2: | |||||||||
| City: | FESTUS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6369312100 | ||||||||
| FaxNumber: | 6369312300 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 116475 | MO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.