Provider Demographics
NPI:1033449723
Name:LETART, HEATHER NICOLE
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:NICOLE
Last Name:LETART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 ROBERTSON RD
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-5246
Mailing Address - Country:US
Mailing Address - Phone:864-450-7017
Mailing Address - Fax:
Practice Address - Street 1:210 N MCDUFFIE ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-5648
Practice Address - Country:US
Practice Address - Phone:864-450-7017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-04
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA57707172M00000X
SC11073225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No172M00000XOther Service ProvidersMechanotherapist