Provider Demographics
NPI:1568623528
Name:WHITE, HEATHER LYNN (LMT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNN
Last Name:WHITE
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 1:111 E LYTLE ST
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-3807
Mailing Address - Country:US
Mailing Address - Phone:972-984-8132
Mailing Address - Fax:
Practice Address - Street 1:111 E LYTLE ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-3807
Practice Address - Country:US
Practice Address - Phone:972-984-8132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN05640225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist