Provider Demographics
NPI:1710008206
Name:KEIRA WIDMER
Entity Type:Organization
Organization Name:KEIRA WIDMER
Other - Org Name:SEED CENTER FOR WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KEIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WIDMER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, CST, RYT
Authorized Official - Phone:480-628-8089
Mailing Address - Street 1:PO BOX 10667
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-0012
Mailing Address - Country:US
Mailing Address - Phone:480-628-8089
Mailing Address - Fax:
Practice Address - Street 1:5440 S LAKESHORE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-2101
Practice Address - Country:US
Practice Address - Phone:480-628-8089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT03104P225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty