Provider Demographics
NPI:1275125437
Name:BOHRISCH, HEATHER NICOLE (PTA, LMT, BCTMB)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:NICOLE
Last Name:BOHRISCH
Suffix:
Gender:F
Credentials:PTA, LMT, BCTMB
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:DAY-NEUTILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12833 W ORANGE DR
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-4102
Mailing Address - Country:US
Mailing Address - Phone:818-661-0867
Mailing Address - Fax:
Practice Address - Street 1:12833 W ORANGE DR
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-4102
Practice Address - Country:US
Practice Address - Phone:818-661-0867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-09
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-26863225700000X
AZPTA-014565225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist