Provider Demographics
NPI:1346382306
Name:MACDONALD, HEATHER LEE (PT,DPT)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:LEE
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 JACKSON ST
Mailing Address - Street 2:REAR
Mailing Address - City:ATTLEBORO FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:02763-1049
Mailing Address - Country:US
Mailing Address - Phone:508-369-3362
Mailing Address - Fax:
Practice Address - Street 1:545 PAWTUCKET AVE
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-6046
Practice Address - Country:US
Practice Address - Phone:401-475-5775
Practice Address - Fax:401-475-5776
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15207225100000X
RI02286225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist