Provider Demographics
NPI:1558448944
Name:PROFF, HEATHER ANN (PT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANN
Last Name:PROFF
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 1:499 HYALITE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-7346
Mailing Address - Country:US
Mailing Address - Phone:406-570-0813
Mailing Address - Fax:
Practice Address - Street 1:4055 VALLEY COMMONS DR STE E2A
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-6432
Practice Address - Country:US
Practice Address - Phone:406-570-0813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1735PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT3401073Medicaid
MT3401088Medicaid