Individual
COREY PHILLIPS NICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1100 WILFORD HALL LOOP, JBSA LACKLAND AFB, SAN ANTONIO, TX 78236
(210) 292-5034
Mailing address
1100 WILFORD HALL LOOP, JBSA LACKLAND AFB, SAN ANTONIO, TX 78236
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1322584
TX
Other
Enumeration date
07/22/2019
Last updated
08/31/2023
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