Provider Demographics
NPI:1780969295
Name:THOMAS, HEATHER RENEE (DPT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:RENEE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2151 ORANGE AVE APT D
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-1871
Mailing Address - Country:US
Mailing Address - Phone:626-485-6561
Mailing Address - Fax:
Practice Address - Street 1:2151 ORANGE AVE APT D
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-1871
Practice Address - Country:US
Practice Address - Phone:626-485-6561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-15
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist