Provider Demographics
NPI:1518677384
Name:LAWDER, HEATHER DAWN MACLEOD (PTA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:DAWN MACLEOD
Last Name:LAWDER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12775 OAK FALLS DR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-3062
Mailing Address - Country:US
Mailing Address - Phone:770-309-1273
Mailing Address - Fax:
Practice Address - Street 1:11190 MEDLOCK BRIDGE RD
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-2578
Practice Address - Country:US
Practice Address - Phone:678-464-7162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA00498225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant