Individual
NICOLE JACKSON VICENTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
210 W PARKWOOD DR, DAYTON, OH 45405-3023
(937) 802-8772
Mailing address
210 W PARKWOOD DR, DAYTON, OH 45405-3023
(937) 802-8772
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
33.016252
OH
Other
Enumeration date
07/04/2010
Last updated
07/21/2022
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