Provider Demographics
NPI:1801186754
Name:IZZI, HEATHER R (LMP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:R
Last Name:IZZI
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12515 MERIDIAN E
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374
Mailing Address - Country:US
Mailing Address - Phone:253-293-6444
Mailing Address - Fax:
Practice Address - Street 1:12515 MERIDIAN E STE 295
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3436
Practice Address - Country:US
Practice Address - Phone:253-256-6071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60212095225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist