Provider Demographics
NPI:1790398477
Name:RANSOM, HEIDI REBEKAH (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:REBEKAH
Last Name:RANSOM
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 N 13TH ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047-1628
Mailing Address - Country:US
Mailing Address - Phone:406-595-2760
Mailing Address - Fax:
Practice Address - Street 1:875 BRIDGER DR UNIT J
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-2303
Practice Address - Country:US
Practice Address - Phone:406-585-9113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLMT-113225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist