MEDICARE: NALSEN BOLIVAR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	142650	TX

General Provider Information

NPI Number	:	1225820202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NALSEN BOLIVAR

Provider Business Mailing Address
First Line	:	8350 ASHLANE WAY STE 203
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77382-2341
Country	:	US
Telephone Number	:	305-890-8419
Fax Number	:

Provider Business Practice Location Address
First Line	:	8350 ASHLANE WAY STE 203
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77382-2341
Country	:	US
Telephone Number	:	305-890-8419
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2025
Last Update Date	:	01/20/2026

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