Provider Demographics
NPI:1386259737
Name:SZYMKOWSKI, NICOLE MICHELLE (LMT)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:MICHELLE
Last Name:SZYMKOWSKI
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 1:3019 BARLOW ST
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-6952
Mailing Address - Country:US
Mailing Address - Phone:989-710-7448
Mailing Address - Fax:
Practice Address - Street 1:3019 BARLOW ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-6952
Practice Address - Country:US
Practice Address - Phone:989-710-7448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-12
Last Update Date:2020-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501011812225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist