Provider Demographics
NPI:1750408308
Name:HEISSERMAN, LINDA RUTH (LMT)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:RUTH
Last Name:HEISSERMAN
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 1:2264 NW WEST HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-1047
Mailing Address - Country:US
Mailing Address - Phone:541-389-0934
Mailing Address - Fax:
Practice Address - Street 1:125 NW GREELEY AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-2913
Practice Address - Country:US
Practice Address - Phone:541-388-4589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLMT 2451225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORLMT 2451OtherMASSAGE THERAPY LICENSE