Provider Demographics
NPI:1699493668
Name:VAN EPS, HEIDI (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:VAN EPS
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15574 EDGEWOOD DR STE 102
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56401-6956
Mailing Address - Country:US
Mailing Address - Phone:218-829-2665
Mailing Address - Fax:
Practice Address - Street 1:15574 EDGEWOOD DR STE 102
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56401-6956
Practice Address - Country:US
Practice Address - Phone:218-829-2665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist