Provider Demographics
NPI:1972137974
Name:BRANCH, HEIDI VERLENE (LMT)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:VERLENE
Last Name:BRANCH
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 1:3022 W ELOIKA AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-7255
Mailing Address - Country:US
Mailing Address - Phone:509-868-3993
Mailing Address - Fax:
Practice Address - Street 1:8701 N DIVISION ST STE F
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1131
Practice Address - Country:US
Practice Address - Phone:509-381-5906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-28
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61049165225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty