Provider Demographics
NPI:1043973522
Name:HOLLIE HEFFERMAN LMT LLC
Entity type:Organization
Organization Name:HOLLIE HEFFERMAN LMT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:HOLLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEFFERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:502-422-8297
Mailing Address - Street 1:915 NE 2ND ST
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-7512
Mailing Address - Country:US
Mailing Address - Phone:503-558-4977
Mailing Address - Fax:971-253-4445
Practice Address - Street 1:915 NE 2ND ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7512
Practice Address - Country:US
Practice Address - Phone:503-661-1302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-20
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty