Provider Demographics
NPI:1164398145
Name:HEATH, ANTHONY W (BA)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:W
Last Name:HEATH
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
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Mailing Address - Street 1:5130 DORIAN ST
Mailing Address - Street 2:
Mailing Address - City:CHUBBUCK
Mailing Address - State:ID
Mailing Address - Zip Code:83202-2918
Mailing Address - Country:US
Mailing Address - Phone:208-915-8448
Mailing Address - Fax:208-240-9257
Practice Address - Street 1:611 WILSON AVE STE 5
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-5046
Practice Address - Country:US
Practice Address - Phone:208-915-8448
Practice Address - Fax:208-240-9257
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-15
Last Update Date:2025-10-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ID225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty