Provider Demographics
NPI:1801190111
Name:DAVIEAU, HEATHER (LMT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:DAVIEAU
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 1:2011 ANCE ST
Mailing Address - Street 2:
Mailing Address - City:STRASBURG
Mailing Address - State:CO
Mailing Address - Zip Code:80136-7848
Mailing Address - Country:US
Mailing Address - Phone:720-383-0292
Mailing Address - Fax:303-622-6321
Practice Address - Street 1:2011 ANCE ST
Practice Address - Street 2:
Practice Address - City:STRASBURG
Practice Address - State:CO
Practice Address - Zip Code:80136-7848
Practice Address - Country:US
Practice Address - Phone:720-383-0292
Practice Address - Fax:303-622-6321
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist