Provider Demographics
NPI:1720849490
Name:THOMAS, HEATHER RENEE (PTA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:RENEE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3789 CAPE LANDING CIR APT F
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-1114
Mailing Address - Country:US
Mailing Address - Phone:184-360-2518
Mailing Address - Fax:
Practice Address - Street 1:3789 CAPE LANDING CIR APT F
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-1114
Practice Address - Country:US
Practice Address - Phone:184-360-2518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4884225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant