Provider Demographics
NPI:1750155768
Name:TRIBU-THOMAS, HEATHER MARIE (LMT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:TRIBU-THOMAS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:MARIE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:PO BOX 262
Mailing Address - Street 2:
Mailing Address - City:ARMADA
Mailing Address - State:MI
Mailing Address - Zip Code:48005-0262
Mailing Address - Country:US
Mailing Address - Phone:810-545-8086
Mailing Address - Fax:
Practice Address - Street 1:74135 CHURCH ST
Practice Address - Street 2:
Practice Address - City:ARMADA
Practice Address - State:MI
Practice Address - Zip Code:48005-3334
Practice Address - Country:US
Practice Address - Phone:810-545-8086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501011054225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist