Provider Demographics
NPI:1538482435
Name:DAVIDSON, HEATHER SMITH (PT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:SMITH
Last Name:DAVIDSON
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 1:2400 HIGHWAY 287 N
Mailing Address - Street 2:STE 116
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-4828
Mailing Address - Country:US
Mailing Address - Phone:888-864-3572
Mailing Address - Fax:
Practice Address - Street 1:2400 HIGHWAY 287 N
Practice Address - Street 2:STE 116
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-4828
Practice Address - Country:US
Practice Address - Phone:888-864-3572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-05
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1100758225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist