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NPI Code Detail

MEDICARE: HEIDI DAVIS LMT

MEDICARE: HEIDI DAVIS LMT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage Therapist14688OR

General Provider Information

NPI Number : 1881975753
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEIDI DAVIS LMT
Provider Business Mailing Address
First Line : 583 IRVING DR
Second Line :
City : MYRTLE CREEK
State : OR
Zip : 97457-7403
Country : US
Telephone Number : 541-643-8286
Fax Number :
Provider Business Practice Location Address
First Line : 960 LIBERTY ST SE STE 170
Second Line :
City : SALEM
State : OR
Zip : 97302-4149
Country : US
Telephone Number : 503-588-6633
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2011
Last Update Date : 09/06/2011

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Directions to “ HEIDI DAVIS LMT” Practice Location

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