Provider Demographics
NPI:1578525002
Name:LAHDENPERA, HEATHER ANNE (LAC, MPT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANNE
Last Name:LAHDENPERA
Suffix:
Gender:F
Credentials:LAC, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4984 VINCENT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-2219
Mailing Address - Country:US
Mailing Address - Phone:310-490-5989
Mailing Address - Fax:
Practice Address - Street 1:1551 COLORADO BLVD
Practice Address - Street 2:STE. 206
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90041-1400
Practice Address - Country:US
Practice Address - Phone:310-490-5989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-02
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC-9302171100000X
CAPT-24320225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist