Provider Demographics
NPI:1356549216
Name:ELLER, HEATHER MARIE (LMP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:ELLER
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 1:10301 SE 147TH AVE
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97236-6061
Mailing Address - Country:US
Mailing Address - Phone:503-679-5642
Mailing Address - Fax:
Practice Address - Street 1:603 SE MORRISON RD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-1545
Practice Address - Country:US
Practice Address - Phone:503-679-5642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016050172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist