Provider Demographics
NPI:1164819124
Name:SALO, HEATHER NICOLE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:NICOLE
Last Name:SALO
Suffix:
Gender:F
Credentials: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 4464
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59702-4464
Mailing Address - Country:US
Mailing Address - Phone:406-565-5085
Mailing Address - Fax:833-406-2356
Practice Address - Street 1:3718 E LAKE DR
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-4388
Practice Address - Country:US
Practice Address - Phone:406-565-5085
Practice Address - Fax:833-406-2356
Is Sole Proprietor?:No
Enumeration Date:2015-04-16
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPTP-PT-LIC-4355225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist