Nicole A Deitrick, LMT

Primary specialty

SpecialistTaxonomy code 174400000X

License

MA29664 Issued in FL

Practice address

1415 10TH St E
Palmetto, FL 34221-4278

Phone

(941) 721-4559

Fax

(941) 721-0142

NPI assigned

Jul 29, 2006

Last updated

Sep 25, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• North River Body Therapies

  • Massage Therapist
  • Ellenton, FL
  • NPI 1083879464
  NPD Authorized official
• North River Body Therapies

  • Massage Therapist
  • Palmetto, FL
  • NPI 1124371380
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758758400000",
    "number": "1184638447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1415 10TH ST E",
            "city": "PALMETTO",
            "state": "FL",
            "postal_code": "342214278",
            "telephone_number": "941-721-4559",
            "fax_number": "941-721-0142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 10TH ST E",
            "city": "PALMETTO",
            "state": "FL",
            "postal_code": "342214278",
            "telephone_number": "941-721-4559",
            "fax_number": "941-721-0142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEITRICK",
        "first_name": "NICOLE",
        "middle_name": "A",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-29",
        "last_updated": "2025-09-25",
        "certification_date": "2025-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "FL",
            "license": "MA29664",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Courtney Davidson
• Nicole L Davis, PHARMD
• Peyton Elise Davis, MS, LAT, ATC
• Jane Arrington Dawson, APRN
• Deep River Psychological Services LLC
• Diamond Family Medicine PLLC Donita Kay Diamond Sole MBR (Diamond Medical Group)
• Melanie Diaz Berrios, DC
• Anita Diaz, COTA
• Suzette Maya Dibattista, OTR/L
• Joseph M Dimino, MD

• Specialist in Palmetto, FL
• Providers in Palmetto, FL by specialty
• Specialist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.