Provider Demographics
NPI:1467584698
Name:HETLAND, HEIDI JO YOUNG (PT, DPT, MS, PCS)
Entity Type:Individual
Prefix:DR
First Name:HEIDI JO
Middle Name:YOUNG
Last Name:HETLAND
Suffix:
Gender:F
Credentials:PT, DPT, MS, PCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 GOLDENVIEW CT
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-8207
Mailing Address - Country:US
Mailing Address - Phone:919-484-8144
Mailing Address - Fax:
Practice Address - Street 1:1214 GOLDENVIEW CT
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-8207
Practice Address - Country:US
Practice Address - Phone:919-698-2970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC51722251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89776OtherBCBS OF NC