Provider Demographics
NPI:1598237067
Name:THYNE, HEATHER (ATC, PA-C)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:THYNE
Suffix:
Gender:F
Credentials:ATC, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:90 TENNYSON AVE
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-2535
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:33 BARTLETT ST STE 206
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1317
Practice Address - Country:US
Practice Address - Phone:978-458-1293
Practice Address - Fax:978-458-6953
Is Sole Proprietor?:No
Enumeration Date:2018-12-21
Last Update Date:2022-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant