Provider Demographics
NPI:1245777564
Name:GEORGIA HEISSER
Entity Type:Organization
Organization Name:GEORGIA HEISSER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:GEORGIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEISSER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:832-849-8298
Mailing Address - Street 1:PO BOX 21285
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77720-1285
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7750 PARK NORTH DR
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77708-2425
Practice Address - Country:US
Practice Address - Phone:832-849-8298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT126192305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX225700000XOtherRESPIRATORY, DEVELOPMENTAL, REHAB & RESTORATIVE SERVICE PROVIDERS