Individual
TARA HEISEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
30544 HIGHWAY 200, PONDERAY, ID 83852-5005
(208) 205-9559
Mailing address
504 N FOREST AVE, SANDPOINT, ID 83864-1925
(717) 368-2462
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MSG010351
PA
Other
Enumeration date
12/15/2025
Last updated
12/15/2025
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