Provider Demographics
NPI:1205857877
Name:DAVIS, HEATHER MARIE (PT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:MARIE
Other - Last Name:HUBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8880 NE 82ND TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64158-1313
Mailing Address - Country:US
Mailing Address - Phone:816-437-8122
Mailing Address - Fax:816-407-9609
Practice Address - Street 1:8880 NE 82ND TER
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64158-1313
Practice Address - Country:US
Practice Address - Phone:816-437-8122
Practice Address - Fax:816-407-9609
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1166568225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist