Provider Demographics
NPI:1144750100
Name:HEERDT, MARY M (PT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:HEERDT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MAGGIE
Other - Middle Name:
Other - Last Name:HEERDT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:4990 HILLSDALE CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-5770
Mailing Address - Country:US
Mailing Address - Phone:916-905-6378
Mailing Address - Fax:916-672-0114
Practice Address - Street 1:5301 LONGLEY LN STE 81
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-1868
Practice Address - Country:US
Practice Address - Phone:916-905-6378
Practice Address - Fax:916-672-0114
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0130264225100000X
NV4420225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist