Healthcare Provider Details

I. General information

NPI: 1467398503
Provider Name (Legal Business Name): SAMANTHA HEAGERTY CMT, CCMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13021 EVERGREEN DR
BAXTER MN
56425-7439
US

IV. Provider business mailing address

13021 EVERGREEN DR
BAXTER MN
56425-7439
US

V. Phone/Fax

Practice location:
  • Phone: 218-368-8313
  • Fax:
Mailing address:
  • Phone: 218-820-6022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: