Provider Demographics
NPI:1376765552
Name:WIDOFF, HEIDI F (RDH, LMT, COM)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:F
Last Name:WIDOFF
Suffix:
Gender:F
Credentials:RDH, LMT, COM
Other - Prefix:MS
Other - First Name:HEIDI
Other - Middle Name:FRAN
Other - Last Name:WIDOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH, LMT, COM
Mailing Address - Street 1:1521 NW 19TH TER APT 101
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-1406
Mailing Address - Country:US
Mailing Address - Phone:818-307-8518
Mailing Address - Fax:
Practice Address - Street 1:1521 NW 19TH TER APT 101
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-1406
Practice Address - Country:US
Practice Address - Phone:818-307-8518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH25120124Q00000X
CA21147124Q00000X
FLMA94167225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No124Q00000XDental ProvidersDental Hygienist