Provider Demographics
NPI:1528209517
Name:PARKER, HEATHER (NCTMB, LMT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:NCTMB, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 DAVIS RD STE D
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-1704
Mailing Address - Country:US
Mailing Address - Phone:706-651-0202
Mailing Address - Fax:706-651-0333
Practice Address - Street 1:106 DAVIS RD STE D
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-1704
Practice Address - Country:US
Practice Address - Phone:706-651-0202
Practice Address - Fax:706-651-0333
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT000857172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist