Provider Demographics
NPI:1861620858
Name:HEIDER, ROBERT PAUL (LMT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:PAUL
Last Name:HEIDER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2765 NE 1ST CT
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-2379
Mailing Address - Country:US
Mailing Address - Phone:971-409-9007
Mailing Address - Fax:
Practice Address - Street 1:4004 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-6871
Practice Address - Country:US
Practice Address - Phone:971-409-9007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12068225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist