Provider Demographics
NPI:1992755102
Name:HEISSENBUTTEL, LILI (AP, LMT)
Entity type:Individual
Prefix:MS
First Name:LILI
Middle Name:
Last Name:HEISSENBUTTEL
Suffix:
Gender:F
Credentials:AP, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 MOCKINGBIRD RD
Mailing Address - Street 2:
Mailing Address - City:KEY LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33037-3887
Mailing Address - Country:US
Mailing Address - Phone:305-852-9963
Mailing Address - Fax:305-852-9963
Practice Address - Street 1:1215 MOCKINGBIRD RD
Practice Address - Street 2:
Practice Address - City:KEY LARGO
Practice Address - State:FL
Practice Address - Zip Code:33037-3887
Practice Address - Country:US
Practice Address - Phone:305-852-9963
Practice Address - Fax:305-852-9963
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLA.P.976171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLA.P.976OtherACUPUNCTURE LICENSE #
FLMA9614OtherMASSAGE LICENSE#