Provider Demographics
NPI:1508565607
Name:SCHMIDT-HEISIG, TERESE MARIE
Entity Type:Individual
Prefix:
First Name:TERESE
Middle Name:MARIE
Last Name:SCHMIDT-HEISIG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TERESE
Other - Middle Name:MARIE
Other - Last Name:MONTOYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2532 N 4TH ST # 278
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-3712
Mailing Address - Country:US
Mailing Address - Phone:602-999-9974
Mailing Address - Fax:
Practice Address - Street 1:2717 N 4TH ST STE 120
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-1813
Practice Address - Country:US
Practice Address - Phone:928-440-8494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist
No132700000XDietary & Nutritional Service ProvidersDietary Manager
No171400000XOther Service ProvidersHealth & Wellness Coach
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist