Doctor Name: | LYNN ANDERSON NICHOLAS |
NPI Number: | 1083745608 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | P.T. |
License Number: | 1024388 |
Business Practice Address: | 5601 Bridge St Suite 230 Fort Worth, TX - 761122384 |
Business Phone Number: | 8773099748 |
Business Fax Number: | 8773099749 |
Mailing Address: | 17 Buccaneer Ct, FORT WORTH |
State: | TX |
Postal Code: | 761793255 |
Phone Number: | 8172368181 |
Fax Number: | 8172365154 |
NPI Enumeration Date: | 03/07/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 1024388 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |