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

Nicklas Lidstrom

Individual provider Athletic Trainer · NPI 1871369603

Nicklas Lidstrom is an Athletic Trainer in Conway, South Carolina. Practices as a sole proprietor. Licensed in South Carolina.

Licensed in
SC
In the registry since
2023

Practice location Address checks out

925 One Landon Loop
Conway, SC 29528
Phone: (843) 349-2825
Show map & directions

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

Specialties & licences

Athletic Trainer (primary) Taxonomy 2255A2300X · Licence AT03472 (SC)

Record details

NPI number1871369603
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedDecember 4, 2023
Last updated in NPPESDecember 4, 2023
Certification dateJune 23, 2023
Mailing address111 Village Center Blvd Unit 2210, Myrtle Beach, SC 29579-6719

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