Provider Demographics
NPI:1144593195
Name:SUMNER, HEATHER LEANE (LPT, DPT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LEANE
Last Name:SUMNER
Suffix:
Gender:F
Credentials:LPT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 232
Mailing Address - Street 2:
Mailing Address - City:VICCO
Mailing Address - State:KY
Mailing Address - Zip Code:41773-0232
Mailing Address - Country:US
Mailing Address - Phone:606-312-2637
Mailing Address - Fax:
Practice Address - Street 1:114 ROWDY HOLW
Practice Address - Street 2:
Practice Address - City:SASSAFRAS
Practice Address - State:KY
Practice Address - Zip Code:41759-8979
Practice Address - Country:US
Practice Address - Phone:606-312-2637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-21
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0057932251P0200X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics