Provider Demographics
NPI:1043764855
Name:(WIMBISH) BROWN, HEATHER (LMT, MTPT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:(WIMBISH) BROWN
Suffix:
Gender:F
Credentials:LMT, MTPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 BABCOCK BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-2564
Mailing Address - Country:US
Mailing Address - Phone:412-651-3680
Mailing Address - Fax:
Practice Address - Street 1:6000 BABCOCK BLVD STE 104
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-2564
Practice Address - Country:US
Practice Address - Phone:412-651-3680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG001319225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA263656767OtherEIN