Individual
IAN NEILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RBT
Contact information
Practice address
12650 N BEACH ST STE 146, FORT WORTH, TX 76244-4253
(682) 238-1872
Mailing address
16800 DALLAS PKWY STE 200, DALLAS, TX 75248-1961
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
RBT-18-56266
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RBT-18-56266
BACB
—
Enumeration date
02/13/2019
Last updated
02/13/2019
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