Provider Demographics
NPI:1225820202
Name:BOLIBAR, NALSEN
Entity type:Individual
Prefix:
First Name:NALSEN
Middle Name:
Last Name:BOLIBAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8350 ASHLANE WAY STE 203
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382-2341
Mailing Address - Country:US
Mailing Address - Phone:305-890-8419
Mailing Address - Fax:
Practice Address - Street 1:8350 ASHLANE WAY STE 203
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77382-2341
Practice Address - Country:US
Practice Address - Phone:305-890-8419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX142650225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist