Provider Demographics
NPI:1780194167
Name:HEIST, KRISTINE VIRGINIA (LMT, BCTMB)
Entity Type:Individual
Prefix:MS
First Name:KRISTINE
Middle Name:VIRGINIA
Last Name:HEIST
Suffix:
Gender:F
Credentials:LMT, BCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 RANKIN RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-4851
Mailing Address - Country:US
Mailing Address - Phone:302-584-7064
Mailing Address - Fax:
Practice Address - Street 1:16C POLLY DRUMMOND HILL RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-5703
Practice Address - Country:US
Practice Address - Phone:302-584-7064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEMT0001815225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist