Healthcare Provider Details

I. General information

NPI: 1750408308
Provider Name (Legal Business Name): LINDA RUTH HEISSERMAN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 NW GREELEY AVE
BEND OR
97701-2913
US

IV. Provider business mailing address

2264 NW WEST HILLS AVE
BEND OR
97701-1047
US

V. Phone/Fax

Practice location:
  • Phone: 541-388-4589
  • Fax:
Mailing address:
  • Phone: 541-389-0934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberLMT 2451
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: