Provider Demographics
NPI:1013317015
Name:HEATH, TAMARA J (PT)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:J
Last Name:HEATH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7519 BEDFORDSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-7519
Mailing Address - Country:US
Mailing Address - Phone:704-651-4334
Mailing Address - Fax:
Practice Address - Street 1:7519 BEDFORDSHIRE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-7519
Practice Address - Country:US
Practice Address - Phone:704-651-4334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP55472251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics