Provider Demographics
NPI:1043084494
Name:WRIGHT-TILLEY, HEIDI (LMT)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:WRIGHT-TILLEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7323 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-2159
Mailing Address - Country:US
Mailing Address - Phone:614-861-6222
Mailing Address - Fax:614-861-1940
Practice Address - Street 1:7323 E MAIN ST
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-2159
Practice Address - Country:US
Practice Address - Phone:614-861-6222
Practice Address - Fax:614-861-1940
Is Sole Proprietor?:No
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33-013837225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist