Provider Demographics
NPI:1346369725
Name:THOMAS, HEATHER N (PT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:N
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2222
Mailing Address - Fax:
Practice Address - Street 1:3330 W 177TH ST
Practice Address - Street 2:SUITE B, 2ND FLOOR
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2184
Practice Address - Country:US
Practice Address - Phone:708-249-8347
Practice Address - Fax:708-249-8348
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070012843225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1619908OtherBCBS IL GROUP
ILP00480711OtherMEDICARE RR PTAN
IL211781OtherMEDICARE GROUP NUMBER- MARTIN R HALL , MD SC
IL568150OtherMEDICARE GROUP NUMBER-ARC HAZELCREST
IL1619908OtherBCBS IL GROUP
IL568150OtherMEDICARE GROUP NUMBER-ARC HAZELCREST