Provider Demographics
NPI:1891384293
Name:HEIGHT, TEHERAN M SR (LMT, NMT)
Entity Type:Individual
Prefix:MR
First Name:TEHERAN
Middle Name:M
Last Name:HEIGHT
Suffix:SR
Gender:M
Credentials:LMT, NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2529 BONDS LAKE RD NW
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-3101
Mailing Address - Country:US
Mailing Address - Phone:678-724-7906
Mailing Address - Fax:
Practice Address - Street 1:737 MAIN ST
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3618
Practice Address - Country:US
Practice Address - Phone:678-724-7906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT011648225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist