Provider Demographics
NPI:1356470942
Name:RADER, HEATHER SIMPSON (PT)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:SIMPSON
Last Name:RADER
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 1:1502 N. DONNELLY ST.
Mailing Address - Street 2:SUITE 108
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757
Mailing Address - Country:US
Mailing Address - Phone:352-409-7603
Mailing Address - Fax:352-589-5747
Practice Address - Street 1:1502 N. DONNELLY ST.
Practice Address - Street 2:SUITE 108
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757
Practice Address - Country:US
Practice Address - Phone:352-409-7603
Practice Address - Fax:352-589-5747
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12044225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist