Individual
MATTHEW NICKERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
100 W CHESTNUT ST, BURLINGTON, WI 53105-1203
(414) 208-4323
Mailing address
536 E DOVER ST, MILWAUKEE, WI 53207-2106
(719) 963-2747
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
15019-146
WI
Other
Enumeration date
09/22/2020
Last updated
09/22/2020
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