Individual
LYNN ANDERSON NICHOLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
5601 BRIDGE ST, SUITE 230, FORT WORTH, TX 76112-2384
(877) 309-9748
(877) 309-9749
Mailing address
17 BUCCANEER CT, FORT WORTH, TX 76179-3255
(817) 236-8181
(817) 236-5154
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1024388
TX
Other
Enumeration date
03/07/2007
Last updated
07/08/2007
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