Provider Demographics
NPI:1568755874
Name:STEVENS, HEATHER J (LMT)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:J
Last Name:STEVENS
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 1:1424 W 600 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84104-2508
Mailing Address - Country:US
Mailing Address - Phone:801-884-9222
Mailing Address - Fax:
Practice Address - Street 1:2180 E 4500 S STE 190
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117-4019
Practice Address - Country:US
Practice Address - Phone:801-884-9222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7949685-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist