Provider Demographics
NPI:1346816162
Name:JUNEAU, HEATHER TERESA (DPT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:TERESA
Last Name:JUNEAU
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 1:4012 NEWLANDS ST
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-4344
Mailing Address - Country:US
Mailing Address - Phone:504-810-7176
Mailing Address - Fax:
Practice Address - Street 1:5606 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:HARAHAN
Practice Address - State:LA
Practice Address - Zip Code:70123-5111
Practice Address - Country:US
Practice Address - Phone:504-733-0254
Practice Address - Fax:504-734-8869
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10870225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist