Healthcare Provider Details

I. General information

NPI: 1477012466
Provider Name (Legal Business Name): ANDREW HEFLIN LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 03/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2676 NORTHPARK DR STE 100
LAFAYETTE CO
80026-3492
US

IV. Provider business mailing address

2676 NORTHPARK DR STE 100
LAFAYETTE CO
80026-3492
US

V. Phone/Fax

Practice location:
  • Phone: 303-666-2242
  • Fax:
Mailing address:
  • Phone: 303-665-2242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT.0021078
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: