Provider Demographics
NPI:1568452472
Name:THOMASON, HEATHER K (PT, DPT, MS)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:K
Last Name:THOMASON
Suffix:
Gender:F
Credentials:PT, DPT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 HUNTINGTON DOWNS
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-8736
Mailing Address - Country:US
Mailing Address - Phone:540-556-0190
Mailing Address - Fax:
Practice Address - Street 1:171 HUNTINGTON DOWNS
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-8736
Practice Address - Country:US
Practice Address - Phone:540-556-0190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305202863225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist