Provider Demographics
NPI:1205070638
Name:MATZ, HEIDI KENANI (LMT)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:KENANI
Last Name:MATZ
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 1:1033 SW YAMHILL ST
Mailing Address - Street 2:STE. 100
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2545
Mailing Address - Country:US
Mailing Address - Phone:503-477-3973
Mailing Address - Fax:
Practice Address - Street 1:1033 SW YAMHILL ST
Practice Address - Street 2:STE. 100
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2545
Practice Address - Country:US
Practice Address - Phone:503-477-3973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13503225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist