Provider Demographics
NPI:1407064835
Name:CARLSON, HEATHER L (PT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:CARLSON
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 1:27790 W HIGHWAY 22 STE 27
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-2396
Mailing Address - Country:US
Mailing Address - Phone:847-649-6000
Mailing Address - Fax:
Practice Address - Street 1:27790 W HIGHWAY 22 STE 27
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-2396
Practice Address - Country:US
Practice Address - Phone:847-649-6000
Practice Address - Fax:847-649-6060
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070011934225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist