Provider Demographics
NPI:1386664464
Name:SALZER-DEVITO, HEATHER (PT, ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:SALZER-DEVITO
Suffix:
Gender:F
Credentials:PT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6523
Mailing Address - Street 2:
Mailing Address - City:BIG BEAR LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:92315-6523
Mailing Address - Country:US
Mailing Address - Phone:909-289-0879
Mailing Address - Fax:
Practice Address - Street 1:42007 FOX FARM ROAD
Practice Address - Street 2:STE 2A
Practice Address - City:BIG BEAR LAKE
Practice Address - State:CA
Practice Address - Zip Code:92315
Practice Address - Country:US
Practice Address - Phone:909-289-0879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25817225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist