Provider Demographics
NPI:1952093346
Name:CEA, NICHOLE (LMT)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:CEA
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 1:200 E CORTEZ DR APT 23
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86351-8911
Mailing Address - Country:US
Mailing Address - Phone:928-202-0254
Mailing Address - Fax:
Practice Address - Street 1:20 BELL ROCK PLZ STE A
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86351-9043
Practice Address - Country:US
Practice Address - Phone:928-202-0254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-21028225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist