Individual
NICKALAS BOULWARE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
118 W MAIN ST, INDEPENDENCE, KS 67301-3511
(620) 331-0999
(620) 331-1065
Mailing address
1650 LYNDON FARM CT STE 300, LOUISVILLE, KY 40223-5005
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
CP055561A
KS
Other
Enumeration date
06/17/2026
Last updated
06/17/2026
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