Healthcare Provider Details

I. General information

NPI: 1437178498
Provider Name (Legal Business Name): NELLIE M BOLMAN L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 03/08/2025
Certification Date: 03/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 OLD LASCASSAS RD APT E43
MURFREESBORO TN
37130-1533
US

IV. Provider business mailing address

1203 OLD LASCASSAS RD APT E43
MURFREESBORO TN
37130-1533
US

V. Phone/Fax

Practice location:
  • Phone: 936-777-0205
  • Fax:
Mailing address:
  • Phone: 936-777-0205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number15208
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: