Provider Demographics
NPI:1063815397
Name:BAGGETT, HEATHER (PT, DPT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:BAGGETT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4550 N MAJOR DR
Mailing Address - Street 2:APT 1721
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77713-8587
Mailing Address - Country:US
Mailing Address - Phone:830-563-7943
Mailing Address - Fax:
Practice Address - Street 1:3515 FANNIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-3815
Practice Address - Country:US
Practice Address - Phone:409-835-0033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1245555225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist