Provider Demographics
NPI:1659962082
Name:MILLAN, HEIDY (LMT)
Entity Type:Individual
Prefix:
First Name:HEIDY
Middle Name:
Last Name:MILLAN
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:ESTANCIAS DEL RIO CALLE CEIBA
Mailing Address - Street 2:C12
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729
Mailing Address - Country:US
Mailing Address - Phone:787-604-6373
Mailing Address - Fax:
Practice Address - Street 1:ESTANCIAS DEL RIO CALLE CEIBA
Practice Address - Street 2:C12
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-0072
Practice Address - Country:US
Practice Address - Phone:787-604-6373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR709225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty