Provider Demographics
NPI:1376730044
Name:PERALTA, HEIDI DAWN (MPT)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:DAWN
Last Name:PERALTA
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2100 MAIN ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-2475
Mailing Address - Country:US
Mailing Address - Phone:714-374-0233
Mailing Address - Fax:714-374-0244
Practice Address - Street 1:2100 MAIN ST
Practice Address - Street 2:SUITE 250
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-2475
Practice Address - Country:US
Practice Address - Phone:714-374-0233
Practice Address - Fax:714-374-0244
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPT29299225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist