Individual provider · Type 1 NPI
Nicole D. Bullock, LBWMT
Massage Therapist · Mequon, WI
NPI number
1023604048
Active
Practice location
10303 N Port Washington Rd Ste 102
Mequon, WI 53092-5760
Mailing address
W140N11945 Country Aire Dr
Germantown, WI 53022-2700
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Massage Therapist Primary | 225700000X | 12824-146 (WI) |
Massage Therapist: An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes.
Other massage therapist providers in Mequon
About NPI 1023604048
Nicole D. Bullock, LBWMT's National Provider Identifier is 1023604048, issued on Dec 14, 2020. The primary taxonomy on file is Massage Therapist (225700000X), and the practice location is in Mequon, WI. The record was last updated on Dec 14, 2020.