NPI 1023604048

Nicole D Bullock, LBWMT

Practitioner Massage Therapist Mequon, WI

Practice location

Address: 10303 N Port Washington Rd STE 102, Mequon, WI 53092-5760
Phone: (262) 505-7950
Mailing address: W140n11945 Country Aire Dr, Germantown, WI 53022-2700

Registered specialties

Massage Therapist Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 225700000X Licence 12824-146 (WI)

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Registry record

NPI: 1023604048
Entity type: Individual
Sex (as registered): Female
NPI issued: 14 Dec 2020
Record last updated: 14 Dec 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.