Provider Demographics
NPI:1003517558
Name:NELSON, NICHOLAS (LMT)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:NELSON
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8951 MCCUTCHINS DR APT 3304
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-1799
Mailing Address - Country:US
Mailing Address - Phone:469-881-5835
Mailing Address - Fax:
Practice Address - Street 1:3900 S STONEBRIDGE DR STE 804
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-8059
Practice Address - Country:US
Practice Address - Phone:469-768-4040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT128059225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist