Individual
HEIDI BROGDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.T.
Contact information
Practice address
12860 NW JARVIS PL APT 4, BANKS, OR 97106-6059
(971) 226-8166
Mailing address
12860 NW JARVIS PL APT 4, BANKS, OR 97106-6059
(971) 226-8166
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
21891
OR
225700000X
Massage Therapist
MT-20575
AZ
Other
Enumeration date
11/10/2016
Last updated
11/10/2016
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