Healthcare Provider Details

I. General information

NPI: 1770400772
Provider Name (Legal Business Name): NICOLE DEHART LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 CALUM DR
LAFAYETTE LA
70508-8385
US

IV. Provider business mailing address

404 CALUM DR
LAFAYETTE LA
70508-8385
US

V. Phone/Fax

Practice location:
  • Phone: 336-578-8559
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number9509
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: