Healthcare Provider Details

I. General information

NPI: 1174222996
Provider Name (Legal Business Name): NICOLE ELIZABETH SHELBY LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2023
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16626 SEA LARK RD
HOUSTON TX
77062-5819
US

IV. Provider business mailing address

107 CLEARVIEW AVE APT 1004
FRIENDSWOOD TX
77546-4055
US

V. Phone/Fax

Practice location:
  • Phone: 281-488-0111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: