Provider Demographics
NPI:1477912269
Name:WHITLEY, HEATHER ASHLEY (LMT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ASHLEY
Last Name:WHITLEY
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:TWIN CITY MASSAGE 510 OLIVER ST
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-4300
Mailing Address - Country:US
Mailing Address - Phone:423-802-9766
Mailing Address - Fax:
Practice Address - Street 1:TWIN CITY MASSAGE 510 OLIVER ST
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-4300
Practice Address - Country:US
Practice Address - Phone:423-802-9766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028607225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist