Individual provider · Type 1 NPI

Nickalas Boulware

Physical Therapy Assistant · Independence, KS

NPI number 1760317804 Active

Practice location

118 W Main St
Independence, KS 67301-3511

Call (620) 331-0999 Map

Fax (620) 331-1065

Mailing address

1650 Lyndon Farm Ct Ste 300
Louisville, KY 40223-5005

Specialties and licenses

TaxonomyCodeLicense
Physical Therapy Assistant Primary 225200000XCP055561A (KS)

Physical Therapy Assistant: (1)Physical therapist assistants are skilled health care providers who are graduates of a physical therapist assistant associate degree program accredited by an agency recognized by the Secretary of the U.S. Department of Education or Council on Postsecondary Accreditation, who assists the physical therapist in providing physical therapy. The supervising physical therapist is directly responsible for the actions of …

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About NPI 1760317804

Nickalas Boulware's National Provider Identifier is 1760317804, issued on Jun 17, 2026. The primary taxonomy on file is Physical Therapy Assistant (225200000X), and the practice location is in Independence, KS. The record was last updated on Jun 17, 2026.