Provider Demographics
NPI:1932523651
Name:CASE, NICHOLE (CMT)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:CASE
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 S HOVER ST STE D
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-7925
Mailing Address - Country:US
Mailing Address - Phone:970-390-8116
Mailing Address - Fax:
Practice Address - Street 1:1260 S HOVER ST STE D
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-7925
Practice Address - Country:US
Practice Address - Phone:970-399-0811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-17
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT0011772225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist