Most Relevant Information
Provider Data
| NPI Number: | 1003215351 |
| Provider Name: | TRACY LYNN NICHOLS PT |
| Entity Type: | Individual |
| Taxonomy Code: | 225100000X |
| Specialty: | Physical Therapist |
| License Number: | 2566 |
Most Important Dates
| Enumeration Date: | 08/21/2014 |
| Last Updated: | 03/26/2022 |
Provider Practice Location
117 NORTHRIDGE DR STE C
VAN BUREN
AR
729566983
Practice Location Phone/Fax
| Phone: | 4794317460 |
| Fax: |
Provider Mailing Location
1515 TRENTON CIR
VAN BUREN
AR
729562838
Provider Mailing Phone/Fax
| Phone: | 4794317460 |
| Fax: | 4797858564 |