Provider Demographics
NPI:1841887601
Name:SOLIS, HEATHER L (LMT)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:L
Last Name:SOLIS
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 1:133 S BUTLER ST STE 201
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-5606
Mailing Address - Country:US
Mailing Address - Phone:608-658-8320
Mailing Address - Fax:
Practice Address - Street 1:133 S BUTLER ST STE 201
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-5606
Practice Address - Country:US
Practice Address - Phone:608-658-8320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13418-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist