Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC003766R | PA |
NPI | 1114023066 |
---|---|
Provider Name | Dr. Thomas Heath |
First Address | Shippensburg, PA 17257-0316 |
Second Address | Shippensburg, PA 17257-9777 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
HE631533 | (02) | PA |