Provider Demographics
NPI:1437385390
Name:PETERSON, HEIDI NICOLE (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:NICOLE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20214 SR 530 NE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-5353
Mailing Address - Country:US
Mailing Address - Phone:425-501-2047
Mailing Address - Fax:
Practice Address - Street 1:16404 SMOKEY POINT BLVD STE 307
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-8417
Practice Address - Country:US
Practice Address - Phone:360-653-0950
Practice Address - Fax:360-653-9887
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-05
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00013930225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist