Provider Demographics
NPI:1093475014
Name:LASKARIS, HEATHER ELOIS (PT, DPT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ELOIS
Last Name:LASKARIS
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 1:2028 W SCHELL DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-2326
Mailing Address - Country:US
Mailing Address - Phone:318-407-0566
Mailing Address - Fax:
Practice Address - Street 1:10474 W THUNDERBIRD BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3015
Practice Address - Country:US
Practice Address - Phone:632-219-4475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32094225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist