Provider Demographics
NPI:1164087763
Name:AMNEUS, HEIDI MARIE (LMT)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:MARIE
Last Name:AMNEUS
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 1:704 N BERTELSEN RD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-1805
Mailing Address - Country:US
Mailing Address - Phone:541-600-0342
Mailing Address - Fax:
Practice Address - Street 1:1695 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-4063
Practice Address - Country:US
Practice Address - Phone:541-600-0342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-08
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR25003225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist