Provider Demographics
NPI:1043973522
Name:HOLLIE HEFFERMAN LMT LLC
Entity Type:Organization
Organization Name:HOLLIE HEFFERMAN LMT LLC
Other - Org Name:HOLLIE HEFFERMAN LMT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:HOLLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEFFERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:502-422-8297
Mailing Address - Street 1:4035 SE 52ND AVE STE B
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-3913
Mailing Address - Country:US
Mailing Address - Phone:503-422-8297
Mailing Address - Fax:
Practice Address - Street 1:4035 SE 52ND AVE STE B
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-3913
Practice Address - Country:US
Practice Address - Phone:971-229-2140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-20
Last Update Date:2021-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty