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General NPI Number Information
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NPI Number | 1588330666
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Entity Type | Individual
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Provider Name | EDWARD SCOTT NICKLAS DPT
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Gender | Male
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Dates
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Enumeration Date | 08/19/2021
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Last Update Date | 04/03/2025
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Provider Practice Location Address
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Address Line | 135 BUNTON CREEK RD STE 302
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City | KYLE
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State | TX
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Zip | 78640-5701
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Country | US
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Telephone | 512-492-3726
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Fax | 512-492-3729
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Provider Business Mailing Address
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Address Line | 101 W LOUIS HENNA BLVD STE 300
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City | AUSTIN
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State | TX
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Zip | 78728-1203
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Country | US
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Telephone | 512-492-3743
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1351611
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License Number State | TX
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