Provider Demographics
NPI:1508287608
Name:ROBERTS, HEATHER DANNIELLE (LMT,MMP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:DANNIELLE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LMT,MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 W 360 N
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-4614
Mailing Address - Country:US
Mailing Address - Phone:435-229-9705
Mailing Address - Fax:
Practice Address - Street 1:840 PINNACLE CT
Practice Address - Street 2:BUILDING 11 SUITE 103
Practice Address - City:MESQUITE
Practice Address - State:NV
Practice Address - Zip Code:89027-3303
Practice Address - Country:US
Practice Address - Phone:435-229-9705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNVMT.628225700000X
UT352467-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist