Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Nickalas Boulware

Individual provider Physical Therapy Assistant · NPI 1760317804

Nickalas Boulware is a Physical Therapy Assistant in Independence, Kansas. Licensed in Kansas. Registered with an NPI since 2026.

Licensed in
KS
In the registry since
2026

Practice location Address checks out

118 W Main St
Independence, KS 67301-3511
Phone: (620) 331-0999
Fax: (620) 331-1065
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapy Assistant (primary) Taxonomy 225200000X · Licence CP055561A (KS)

Record details

NPI number1760317804
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedJune 17, 2026
Last updated in NPPESJune 17, 2026
Certification dateJune 17, 2026
Mailing address1650 Lyndon Farm Ct Ste 300, Louisville, KY 40223-5005

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