Provider Demographics
NPI:1124599907
Name:HEPPNER, AMANDA D (LMT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:D
Last Name:HEPPNER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 N 14TH RD
Mailing Address - Street 2:
Mailing Address - City:WORDEN
Mailing Address - State:MT
Mailing Address - Zip Code:59088-2116
Mailing Address - Country:US
Mailing Address - Phone:406-861-9825
Mailing Address - Fax:406-206-0064
Practice Address - Street 1:2504 N 14TH RD
Practice Address - Street 2:
Practice Address - City:WORDEN
Practice Address - State:MT
Practice Address - Zip Code:59088-2116
Practice Address - Country:US
Practice Address - Phone:406-861-9825
Practice Address - Fax:406-206-0064
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-05
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK158333225700000X
WA60914214225700000X
225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK158333OtherMASSAGE THERAPY
WA60914214OtherMASSAGE THERAPY