Provider Demographics
NPI:1558317511
Name:HEATH, CHRISTIE SULLIVAN (PT)
Entity type:Individual
Prefix:MRS
First Name:CHRISTIE
Middle Name:SULLIVAN
Last Name:HEATH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:CHRISTIE
Other - Middle Name:LAUREN
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1219 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-2347
Mailing Address - Country:US
Mailing Address - Phone:225-658-7751
Mailing Address - Fax:225-658-7753
Practice Address - Street 1:1219 CHURCH ST
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-2347
Practice Address - Country:US
Practice Address - Phone:225-658-7751
Practice Address - Fax:225-658-7753
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3583174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist