Provider Demographics
NPI:1255935433
Name:HEATH, NANCY MARIE (LMBT, YTT, MONTRICE)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:MARIE
Last Name:HEATH
Suffix:
Gender:F
Credentials:LMBT, YTT, MONTRICE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 PEYTON ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-3437
Mailing Address - Country:US
Mailing Address - Phone:757-615-5576
Mailing Address - Fax:
Practice Address - Street 1:504 PEYTON ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-3437
Practice Address - Country:US
Practice Address - Phone:757-615-5576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-28
Last Update Date:2020-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6827225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist