Provider Demographics
NPI:1003067893
Name:GOUTERMONT, HEATHER MARIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:MARIE
Last Name:GOUTERMONT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 BANKS BLVD
Mailing Address - Street 2:
Mailing Address - City:SILVER BAY
Mailing Address - State:MN
Mailing Address - Zip Code:55614-1337
Mailing Address - Country:US
Mailing Address - Phone:218-353-8682
Mailing Address - Fax:218-226-6336
Practice Address - Street 1:45 BANKS BLVD
Practice Address - Street 2:
Practice Address - City:SILVER BAY
Practice Address - State:MN
Practice Address - Zip Code:55614-1337
Practice Address - Country:US
Practice Address - Phone:218-353-8682
Practice Address - Fax:218-226-6336
Is Sole Proprietor?:No
Enumeration Date:2008-10-10
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8187225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist