Provider Demographics
NPI:1376968305
Name:HEISE, MARTHA LYN (LMT)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:LYN
Last Name:HEISE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
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Mailing Address - Street 1:493 HIDDEN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18302-9162
Mailing Address - Country:US
Mailing Address - Phone:570-424-0408
Mailing Address - Fax:888-378-1829
Practice Address - Street 1:243 E BROWN ST
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-3005
Practice Address - Country:US
Practice Address - Phone:570-216-8242
Practice Address - Fax:888-378-1829
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMSG003313225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist