Provider Demographics
NPI:1528378171
Name:LANDRY, HEATHER BUCKLEY (PT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:BUCKLEY
Last Name:LANDRY
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 1:1948 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-8273
Mailing Address - Country:US
Mailing Address - Phone:828-244-3077
Mailing Address - Fax:828-771-7905
Practice Address - Street 1:1948 PLAZA DR
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-8273
Practice Address - Country:US
Practice Address - Phone:828-244-3077
Practice Address - Fax:828-771-7905
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2013-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC87322251P0200X, 225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic