Provider Demographics
NPI:1437302155
Name:HEIM, LARRY ARNOLD (LMT)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:ARNOLD
Last Name:HEIM
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14210 DELWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ELBERT
Mailing Address - State:CO
Mailing Address - Zip Code:80106-8882
Mailing Address - Country:US
Mailing Address - Phone:719-495-4519
Mailing Address - Fax:
Practice Address - Street 1:14210 DELWOOD DR
Practice Address - Street 2:
Practice Address - City:ELBERT
Practice Address - State:CO
Practice Address - Zip Code:80106-8882
Practice Address - Country:US
Practice Address - Phone:719-495-4519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-25
Last Update Date:2008-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO711078225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist