Healthcare Provider Details

I. General information

NPI: 1336795426
Provider Name (Legal Business Name): HEIDI HUFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2019
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 BELLWETHER WAY STE 101
BELLINGHAM WA
98225-2966
US

IV. Provider business mailing address

1010 RAILROAD AVE APT 302
BELLINGHAM WA
98225-5183
US

V. Phone/Fax

Practice location:
  • Phone: 360-200-7412
  • Fax:
Mailing address:
  • Phone: 480-329-1248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60964074
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: