Provider Demographics
NPI:1841536356
Name:ZULTOWSKI, NICOLLE PERROTTO (LAC, LMT, LMI)
Entity type:Individual
Prefix:
First Name:NICOLLE
Middle Name:PERROTTO
Last Name:ZULTOWSKI
Suffix:
Gender:F
Credentials:LAC, LMT, LMI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1776 WOODSTEAD CT
Mailing Address - Street 2:LEVEL 1 SUITE 104
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-1458
Mailing Address - Country:US
Mailing Address - Phone:281-466-2585
Mailing Address - Fax:
Practice Address - Street 1:1776 WOODSTEAD CT
Practice Address - Street 2:LEVEL 1 SUITE 104
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-1458
Practice Address - Country:US
Practice Address - Phone:281-466-2585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-02
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00952171100000X
TXMT028251174400000X
TXMI2255174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No174400000XOther Service ProvidersSpecialist
No174H00000XOther Service ProvidersHealth Educator