Healthcare Provider Details

I. General information

NPI: 1962321174
Provider Name (Legal Business Name): IAN R HEATON LMBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 DAVIDSON GATEWAY DR STE 100
DAVIDSON NC
28036-7034
US

IV. Provider business mailing address

13007 MEADOWMERE RD
HUNTERSVILLE NC
28078-2245
US

V. Phone/Fax

Practice location:
  • Phone: 704-559-9287
  • Fax:
Mailing address:
  • Phone: 240-645-5599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number23120
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: