Provider Demographics
NPI:1922182864
Name:ROSENTHAL, HEATHER M (LMP)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:M
Last Name:ROSENTHAL
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:PO BOX 233
Mailing Address - Street 2:
Mailing Address - City:CHATTAROY
Mailing Address - State:WA
Mailing Address - Zip Code:99003-0233
Mailing Address - Country:US
Mailing Address - Phone:509-220-5505
Mailing Address - Fax:
Practice Address - Street 1:12310 N DIVISION ST
Practice Address - Street 2:STE. 105
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1998
Practice Address - Country:US
Practice Address - Phone:509-466-1117
Practice Address - Fax:509-464-0578
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014727225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist