Provider Demographics
NPI:1174911036
Name:MARTINEZ-HEINRICH, TARA (LAC, LMT)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:MARTINEZ-HEINRICH
Suffix:
Gender:F
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:HEINRICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC, LMT
Mailing Address - Street 1:10620 POMMEL CT
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-9321
Mailing Address - Country:US
Mailing Address - Phone:303-564-3256
Mailing Address - Fax:
Practice Address - Street 1:12919 STROH RANCH CT
Practice Address - Street 2:UNIT B
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-7707
Practice Address - Country:US
Practice Address - Phone:303-564-3256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-30
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1984171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist