Healthcare Provider Details

I. General information

NPI: 1770311631
Provider Name (Legal Business Name): HEIDI BETCHER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1480 LINCOLN AVE STE 8
SAN RAFAEL CA
94901-2085
US

IV. Provider business mailing address

6 BULKLEY AVE
SAUSALITO CA
94965-2208
US

V. Phone/Fax

Practice location:
  • Phone: 415-456-1050
  • Fax:
Mailing address:
  • Phone: 808-634-5238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number73180
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: