Provider Demographics
NPI:1417935792
Name:AGUSTINES, HEATHER WOODS (PT)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:WOODS
Last Name:AGUSTINES
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 1:167 S SANTA CLAUS LN STE B
Mailing Address - Street 2:
Mailing Address - City:NORTH POLE
Mailing Address - State:AK
Mailing Address - Zip Code:99705-7755
Mailing Address - Country:US
Mailing Address - Phone:907-488-4978
Mailing Address - Fax:907-488-4976
Practice Address - Street 1:167 S SANTA CLAUS LN
Practice Address - Street 2:
Practice Address - City:NORTH POLE
Practice Address - State:AK
Practice Address - Zip Code:99705-7755
Practice Address - Country:US
Practice Address - Phone:907-488-4978
Practice Address - Fax:907-488-4976
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK928225100000X
CAPT20087225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPT3868Medicaid
AK160166Medicare ID - Type Unspecified