Provider Demographics
NPI:1073391454
Name:LUSMAT, NICOLETTE (LMT)
Entity Type:Individual
Prefix:
First Name:NICOLETTE
Middle Name:
Last Name:LUSMAT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 BEECHER RD STE B
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-4562
Mailing Address - Country:US
Mailing Address - Phone:614-855-5533
Mailing Address - Fax:614-855-5566
Practice Address - Street 1:428 BEECHER RD STE B
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-4562
Practice Address - Country:US
Practice Address - Phone:614-855-5533
Practice Address - Fax:614-855-5566
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.026048225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist