Provider Demographics
NPI:1598262354
Name:ANDRESEN, HEATHER LYNN (MSPT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNN
Last Name:ANDRESEN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5023 KING WILLIAM RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-3129
Mailing Address - Country:US
Mailing Address - Phone:804-928-7730
Mailing Address - Fax:
Practice Address - Street 1:141 OPAL LN
Practice Address - Street 2:
Practice Address - City:MONTROSS
Practice Address - State:VA
Practice Address - Zip Code:22520-2704
Practice Address - Country:US
Practice Address - Phone:804-493-8018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305202723225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist