Provider Demographics
NPI:1427660059
Name:STUART, HEATHER RENEE (LMT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:RENEE
Last Name:STUART
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2216 PADRE BLVD STE B162
Mailing Address - Street 2:
Mailing Address - City:S PADRE ISLE
Mailing Address - State:TX
Mailing Address - Zip Code:78597-0204
Mailing Address - Country:US
Mailing Address - Phone:956-407-3161
Mailing Address - Fax:
Practice Address - Street 1:2216 PADRE BLVD STE B162
Practice Address - Street 2:
Practice Address - City:S PADRE ISLE
Practice Address - State:TX
Practice Address - Zip Code:78597-0204
Practice Address - Country:US
Practice Address - Phone:956-407-3161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT035690225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist