Provider Demographics
NPI:1760747778
Name:COUCH, HEATHER (LMT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:COUCH
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 1:2144 MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-8402
Mailing Address - Country:US
Mailing Address - Phone:303-678-7170
Mailing Address - Fax:303-678-7134
Practice Address - Street 1:2144 MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-8402
Practice Address - Country:US
Practice Address - Phone:303-678-7170
Practice Address - Fax:303-678-7134
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7363225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist