Provider Demographics
NPI:1417259052
Name:HUETTE, NICHOLAS (LMT)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:HUETTE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 PRIMROSE CT
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-6829
Mailing Address - Country:US
Mailing Address - Phone:319-325-7765
Mailing Address - Fax:
Practice Address - Street 1:24 STURGIS CORNER DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52246-5617
Practice Address - Country:US
Practice Address - Phone:319-688-2974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04268225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist