Provider Demographics
NPI:1952561664
Name:HADL, NICHOLAS (LMT)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:HADL
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 1:2908 SAN ROCENDO ST
Mailing Address - Street 2:4031
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-0672
Mailing Address - Country:US
Mailing Address - Phone:817-308-9958
Mailing Address - Fax:
Practice Address - Street 1:800 5TH AVE
Practice Address - Street 2:150
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7300
Practice Address - Country:US
Practice Address - Phone:817-308-9958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT031930225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist