Provider Demographics
NPI:1801230131
Name:BOSSLER, HEATHER K (CMT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:K
Last Name:BOSSLER
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1449 MARYLAND ST APT 2
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1091
Mailing Address - Country:US
Mailing Address - Phone:216-701-9702
Mailing Address - Fax:
Practice Address - Street 1:16237 MACK AVE STE 1
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48224-3645
Practice Address - Country:US
Practice Address - Phone:216-701-9702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist