Provider Demographics
NPI:1205401759
Name:FEARS, HEATHER ROSE
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ROSE
Last Name:FEARS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:ROSE
Other - Last Name:MOVRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1610 SOUTHVIEW LN
Mailing Address - Street 2:
Mailing Address - City:ALBERT LEA
Mailing Address - State:MN
Mailing Address - Zip Code:56007-1860
Mailing Address - Country:US
Mailing Address - Phone:320-221-0161
Mailing Address - Fax:
Practice Address - Street 1:1861 EAGLE VIEW CIR
Practice Address - Street 2:
Practice Address - City:ALBERT LEA
Practice Address - State:MN
Practice Address - Zip Code:56007-1818
Practice Address - Country:US
Practice Address - Phone:507-373-8226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA2669225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant