Provider Demographics
NPI:1629328059
Name:NELSON, HEIDI MARIE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:MARIE
Last Name:NELSON
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 1:1900 NE DIVISION ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-3525
Mailing Address - Country:US
Mailing Address - Phone:541-241-6488
Mailing Address - Fax:
Practice Address - Street 1:1900 NE DIVISION ST
Practice Address - Street 2:SUITE 106
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3525
Practice Address - Country:US
Practice Address - Phone:541-241-6488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19196172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist