Provider Demographics
NPI:1922211002
Name:CHRISMAN, HEIDI A (LMP)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:A
Last Name:CHRISMAN
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 1:1000 TOWN CTR NE STE 180 PMB #124
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98422-1194
Mailing Address - Country:US
Mailing Address - Phone:253-719-0444
Mailing Address - Fax:
Practice Address - Street 1:5015 VARCO RD NE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98422-1805
Practice Address - Country:US
Practice Address - Phone:253-719-0444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00012231225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist