Individual
PEGGY LUCILLE HEATHERLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
708 E UNAKA AVE, SUITE 3, JOHNSON CITY, TN 37601-4128
(423) 943-1600
Mailing address
PO BOX 1133, JOHNSON CITY, TN 37605-1133
(423) 943-1600
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
0000004981
TN
Other
Enumeration date
05/12/2014
Last updated
10/09/2014
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