Provider Demographics
NPI:1477952943
Name:EMBRY, HEATHER (PT)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:
Last Name:EMBRY
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 1:2350 FOLK REAM RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45502-8453
Mailing Address - Country:US
Mailing Address - Phone:937-605-1422
Mailing Address - Fax:
Practice Address - Street 1:2350 FOLK REAM RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45502-8453
Practice Address - Country:US
Practice Address - Phone:937-605-1422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH006235225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist