Healthcare Provider Details

I. General information

NPI: 1235301037
Provider Name (Legal Business Name): EMILY NELL HEYTVELT LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1256 SE BISHOP BLVD 'N'
PULLMAN WA
99163
US

IV. Provider business mailing address

1256 SE BISHOP BLVD 'N'
PULLMAN WA
99163
US

V. Phone/Fax

Practice location:
  • Phone: 509-432-6541
  • Fax:
Mailing address:
  • Phone: 509-432-6541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00023130
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: