Provider Demographics
NPI:1316311376
Name:BAUER, HEATHER LEEANN (LMT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LEEANN
Last Name:BAUER
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 1:3603 SE GRANT CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-5837
Mailing Address - Country:US
Mailing Address - Phone:503-998-8973
Mailing Address - Fax:
Practice Address - Street 1:7155 SW VARNS ST
Practice Address - Street 2:SUITE 110
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8174
Practice Address - Country:US
Practice Address - Phone:971-599-3603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-13
Last Update Date:2016-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21588225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist