Healthcare Provider Details

I. General information

NPI: 1508157686
Provider Name (Legal Business Name): CYNTHIA NOLAN P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2011
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6320 SOUTHWEST BLVD STE 200
BENBROOK TX
76109-6961
US

IV. Provider business mailing address

6320 SOUTHWEST BLVD STE 200
BENBROOK TX
76109-6961
US

V. Phone/Fax

Practice location:
  • Phone: 817-766-5500
  • Fax: 817-766-5501
Mailing address:
  • Phone: 817-766-5500
  • Fax: 817-766-5501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1084291
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: