Doctor Name: | HEIDI ANNETTE WAGONHAUSER |
NPI Number: | 1720366123 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMT |
License Number: | 634 |
Business Practice Address: | 1400 29th St S Fl 2 Great Falls, MT - 594055353 |
Business Phone Number: | 4067613767 |
Business Fax Number: | 4067613038 |
Mailing Address: | 1400 29th St S Fl 2, GREAT FALLS |
State: | MT |
Postal Code: | 594055353 |
Phone Number: | 4067613767 |
Fax Number: | 4067613038 |
NPI Enumeration Date: | 08/02/2011 |
NPI Last Update Date: | 08/02/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | 634 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MT |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |