Provider Demographics
NPI:1306019997
Name:WERTZ, HEATHER MARIE (LMP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:WERTZ
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:MARIE
Other - Last Name:SCHROCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2291
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98507-2291
Mailing Address - Country:US
Mailing Address - Phone:360-943-6206
Mailing Address - Fax:360-943-6276
Practice Address - Street 1:1645 COOPER POINT RD S.W.
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502
Practice Address - Country:US
Practice Address - Phone:360-943-6206
Practice Address - Fax:360-943-6276
Is Sole Proprietor?:No
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00025039225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist