1265462352 NPI number — MRS. HEATHER RUTH HALSETH ATC/R

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265462352 NPI number — MRS. HEATHER RUTH HALSETH ATC/R

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALSETH
Provider First Name:
HEATHER
Provider Middle Name:
RUTH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ATC/R
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GARRIS
Provider Other First Name:
HEATHER
Provider Other Middle Name:
R
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
ATC/R
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265462352
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2727 LEO HARRIS PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EUGENE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97401-8835
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-346-2257
Provider Business Mailing Address Fax Number:
855-850-1265

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1590 EAST 13TH AVE
Provider Second Line Business Practice Location Address:
CLINIC B
Provider Business Practice Location Address City Name:
EUGENE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-346-4470
Provider Business Practice Location Address Fax Number:
855-850-1265
Provider Enumeration Date:
07/04/2006

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: 2255A2300X , with the licence number:  AT-AT-1006886 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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