Provider Demographics
NPI:1093960510
Name:HEROUX, HEATHER D (MSPT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:D
Last Name:HEROUX
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:D
Other - Last Name:SCHREIBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 ROE AVE
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14905-1629
Mailing Address - Country:US
Mailing Address - Phone:607-737-4131
Mailing Address - Fax:607-735-5710
Practice Address - Street 1:602 IVY ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14905-1646
Practice Address - Country:US
Practice Address - Phone:607-737-4131
Practice Address - Fax:607-735-5710
Is Sole Proprietor?:No
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029818-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist