Provider Demographics
NPI:1336491802
Name:AKGUN, HEATHER MANCE (MPT, DPT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MANCE
Last Name:AKGUN
Suffix:
Gender:F
Credentials:MPT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2777 JEFFERSON DAVIS HWY
Mailing Address - Street 2:SUITE 109
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-8323
Mailing Address - Country:US
Mailing Address - Phone:540-318-8615
Mailing Address - Fax:540-318-8619
Practice Address - Street 1:2777 JEFFERSON DAVIS HWY
Practice Address - Street 2:SUITE 109
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-8323
Practice Address - Country:US
Practice Address - Phone:540-318-8615
Practice Address - Fax:540-318-8619
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203138225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist