Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 577 | TN |
NPI | 1003035981 |
---|---|
Provider Name | Mrs. Allene Proctor Heaton |
First Address | Kingsport, TN 37664-2011 |
Second Address | Kingsport, TN 37660-3220 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 08/07/2007 |