Provider Demographics
NPI:1437332103
Name:TEACH, HEATHER MARIE (LMT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:TEACH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 NE 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2997
Mailing Address - Country:US
Mailing Address - Phone:503-892-2835
Mailing Address - Fax:
Practice Address - Street 1:606 NE 20TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2997
Practice Address - Country:US
Practice Address - Phone:503-892-2835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11576172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist