Provider Demographics
NPI:1023588142
Name:CHAPMAN, HEATHER RENNEA (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:RENNEA
Last Name:CHAPMAN
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2333 MACCORKLE AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:WV
Mailing Address - Zip Code:25177-2011
Mailing Address - Country:US
Mailing Address - Phone:304-550-2026
Mailing Address - Fax:
Practice Address - Street 1:2333 MACCORKLE AVE STE 106
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:WV
Practice Address - Zip Code:25177-2011
Practice Address - Country:US
Practice Address - Phone:304-550-2026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-01
Last Update Date:2018-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2018-3576225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist