Individual
NICKEY DAWN COLCLASURE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
2711 SE I ST STE 11, BENTONVILLE, AR 72712-3209
(479) 256-2170
Mailing address
813 S 28TH ST, ROGERS, AR 72758-3915
(479) 256-2170
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
7782
AR
Other
Enumeration date
05/08/2023
Last updated
05/08/2023
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