Provider Demographics
NPI:1518002542
Name:JEFFERY, HEATHER GLENETTE (DPT)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:GLENETTE
Last Name:JEFFERY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:HEATHER
Other - Middle Name:GLENETTE
Other - Last Name:HIPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:252 W OBRECHT RD
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-7703
Mailing Address - Country:US
Mailing Address - Phone:443-609-4903
Mailing Address - Fax:
Practice Address - Street 1:844 WASHINGTON RD STE 101
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6664
Practice Address - Country:US
Practice Address - Phone:410-876-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22097225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist