Provider Demographics
NPI:1568200194
Name:MATCHAM CMT, HEIDI REBECCA (CMT)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:REBECCA
Last Name:MATCHAM CMT
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:REBECCA
Other - Last Name:SEAMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CMT
Mailing Address - Street 1:6376 PINE CONE CT
Mailing Address - Street 2:
Mailing Address - City:FORESTHILL
Mailing Address - State:CA
Mailing Address - Zip Code:95631-9684
Mailing Address - Country:US
Mailing Address - Phone:707-771-0088
Mailing Address - Fax:
Practice Address - Street 1:6376 PINE CONE CT
Practice Address - Street 2:
Practice Address - City:FORESTHILL
Practice Address - State:CA
Practice Address - Zip Code:95631-9684
Practice Address - Country:US
Practice Address - Phone:707-771-0088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist