Provider Demographics
NPI:1043758873
Name:BOST, HEATH (LMBT)
Entity type:Individual
Prefix:MR
First Name:HEATH
Middle Name:
Last Name:BOST
Suffix:
Gender:M
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6771 GOLDFISH RD
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28083-8121
Mailing Address - Country:US
Mailing Address - Phone:704-701-8495
Mailing Address - Fax:
Practice Address - Street 1:121 W COUNCIL ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-4377
Practice Address - Country:US
Practice Address - Phone:704-701-8495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15835225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist