Provider Demographics
NPI:1548465396
Name:THIBODEAU, HEATHER HAYNES (DPT)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:HAYNES
Last Name:THIBODEAU
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-2615
Mailing Address - Country:US
Mailing Address - Phone:703-229-6644
Mailing Address - Fax:
Practice Address - Street 1:5165 11TH ST S
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-3231
Practice Address - Country:US
Practice Address - Phone:703-933-0297
Practice Address - Fax:703-933-0697
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21144174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist