Provider Demographics
NPI:1245854942
Name:HEIN, TERI LYNN (LMT)
Entity type:Individual
Prefix:
First Name:TERI
Middle Name:LYNN
Last Name:HEIN
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 1:513 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:MISSOURI VALLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51555-1207
Mailing Address - Country:US
Mailing Address - Phone:402-980-3657
Mailing Address - Fax:
Practice Address - Street 1:11316 DAVENPORT ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-2630
Practice Address - Country:US
Practice Address - Phone:402-980-3657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA094565225700000X
NE2372225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1891318150OtherNATIONAL PLAN & PROVIDER ENUMERATION SYSTEM