Provider Demographics
NPI:1124999594
Name:CARMODY, HEATHER (LMT, CLT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:CARMODY
Suffix:
Gender:F
Credentials:LMT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-2908
Mailing Address - Country:US
Mailing Address - Phone:516-428-8342
Mailing Address - Fax:
Practice Address - Street 1:153 W 27TH ST STE 404
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-0399
Practice Address - Country:US
Practice Address - Phone:212-691-0330
Practice Address - Fax:212-691-0880
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017406225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist