| Doctor Name: | NICHOLAS GUY WISMANN |
| NPI Number: | 1104058742 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LAC, LMP |
| License Number: | MT-4817 |
| Business Practice Address: | 6881 S Holly Cir 207 Centennial, CO - 801121145 |
| Business Phone Number: | 3033014185 |
| Business Fax Number: | |
| Mailing Address: | 3714 Bucknell Dr, HIGHLANDS RANCH |
| State: | CO |
| Postal Code: | 801294397 |
| Phone Number: | 3033014185 |
| Fax Number: | |
| NPI Enumeration Date: | 08/16/2009 |
| NPI Last Update Date: | 09/13/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225700000X |
| License Number: | MT-4817 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CO |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Massage Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |