MEDICARE: NICHOLE CROCKETT LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MT.0024808	CO

General Provider Information

NPI Number	:	1760318869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLE CROCKETT LMT

Provider Business Mailing Address
First Line	:	5094 PALOMA ST
Second Line	:
City	:	BRIGHTON
State	:	CO
Zip	:	80601-5338
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1401 E BRIDGE ST STE 110
Second Line	:
City	:	BRIGHTON
State	:	CO
Zip	:	80601-1950
Country	:	US
Telephone Number	:	402-657-1401
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2026
Last Update Date	:	06/18/2026

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