Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Nicole D Bullock, LBWMT

Individual provider Massage Therapist · NPI 1023604048

Nicole D Bullock, LBWMT is a Massage Therapist in Mequon, Wisconsin. Practices as a sole proprietor. Licensed in Wisconsin.

Licensed in
WI
In the registry since
2020

Practice location Address checks out

10303 N Port Washington Rd Ste 102
Mequon, WI 53092-5760
Phone: (262) 505-7950
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Massage Therapist (primary) Taxonomy 225700000X · Licence 12824-146 (WI)

Record details

NPI number1023604048
Entity typeIndividual (Type 1)
GenderFemale
Credentials LBWMT
Sole proprietorYes
NPI enumeratedDecember 14, 2020
Last updated in NPPESDecember 14, 2020
Certification dateDecember 14, 2020

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