Healthcare Provider Details

I. General information

NPI: 1275881344
Provider Name (Legal Business Name): HEIDI A TENA L.M.T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2012
Last Update Date: 08/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

396 E 18TH AVE
EUGENE OR
97401-4158
US

IV. Provider business mailing address

396 E 18TH AVE
EUGENE OR
97401-4158
US

V. Phone/Fax

Practice location:
  • Phone: 541-687-7775
  • Fax: 541-687-7780
Mailing address:
  • Phone: 541-687-7775
  • Fax: 541-687-7780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number16458
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: