Healthcare Provider Details

I. General information

NPI: 1760318869
Provider Name (Legal Business Name): NICHOLE CROCKETT LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 E BRIDGE ST STE 110
BRIGHTON CO
80601-1950
US

IV. Provider business mailing address

5094 PALOMA ST
BRIGHTON CO
80601-5338
US

V. Phone/Fax

Practice location:
  • Phone: 402-657-1401
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT.0024808
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: