Provider Demographics
NPI:1063979755
Name:LIEN, HEIDI (PT)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:LIEN
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:
Other - Last Name:TEACHOUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:513 FAWCETT ST
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-7003
Mailing Address - Country:US
Mailing Address - Phone:530-210-6507
Mailing Address - Fax:
Practice Address - Street 1:2007 VEERY
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-0294
Practice Address - Country:US
Practice Address - Phone:530-306-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-28
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1403931225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist