1124599907 NPI number — AMANDA D HEPPNER LMT

Table of content: AMANDA D HEPPNER LMT (NPI 1124599907)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124599907 NPI number — AMANDA D HEPPNER LMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEPPNER
Provider First Name:
AMANDA
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124599907
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2504 N 14TH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WORDEN
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59088-2116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-861-9825
Provider Business Mailing Address Fax Number:
406-206-0064

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2504 N 14TH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WORDEN
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59088-2116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-861-9825
Provider Business Practice Location Address Fax Number:
406-206-0064
Provider Enumeration Date:
12/05/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  158333 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225700000X , with the licence number: 60914214 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225700000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 158333 . This is a "MASSAGE THERAPY" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 60914214 . This is a "MASSAGE THERAPY" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".