Provider Demographics
NPI:1801211685
Name:LINDSTROM, HEATHER MARIE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:MARIE
Last Name:LINDSTROM
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:MARIE
Other - Last Name:DROLLINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1212 W MYSTERY AVE
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654
Mailing Address - Country:US
Mailing Address - Phone:907-521-8002
Mailing Address - Fax:509-834-7696
Practice Address - Street 1:1212 W MYSTERY AVE
Practice Address - Street 2:UNIT B
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-6335
Practice Address - Country:US
Practice Address - Phone:509-426-0131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-03
Last Update Date:2023-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK115364225700000X
AK210076225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist