Provider Demographics
NPI:1215206255
Name:SUGG, HEATHER KRISTINE (DPT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:KRISTINE
Last Name:SUGG
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 1:18350 MOUNT LANGLEY ST STE 105
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-6923
Mailing Address - Country:US
Mailing Address - Phone:714-965-2324
Mailing Address - Fax:714-965-2684
Practice Address - Street 1:18350 MOUNT LANGLEY ST STE 105
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6923
Practice Address - Country:US
Practice Address - Phone:714-965-2324
Practice Address - Fax:714-965-2684
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA385682251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics