Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1043542475 |
---|---|
Provider Name | Ms. Heidi K Manheim |
First Address | Santa Monica, CA 90404-2033 |
Second Address | Santa Monica, CA 90404-2033 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2010 |
Last Update Date | 10/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
#22 | MENTAL HEALTH REHABILITATION SPECIALIST (01) | CA |