Provider Demographics
NPI:1225177520
Name:FREDERICK, HEATHER L (PT)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:L
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:PT
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 337
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036-0337
Mailing Address - Country:US
Mailing Address - Phone:803-345-3811
Mailing Address - Fax:803-345-3018
Practice Address - Street 1:1525 CHAPIN RD
Practice Address - Street 2:
Practice Address - City:CHAPIN
Practice Address - State:SC
Practice Address - Zip Code:29036-0337
Practice Address - Country:US
Practice Address - Phone:803-345-3811
Practice Address - Fax:803-345-3018
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4075208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation