Provider Demographics
NPI:1619926698
Name:NORTH, HEATHER L (PT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:NORTH
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 1:120 GRANDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-1858
Mailing Address - Country:US
Mailing Address - Phone:716-417-4390
Mailing Address - Fax:
Practice Address - Street 1:100 COLLEGE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14221-6800
Practice Address - Country:US
Practice Address - Phone:716-626-0093
Practice Address - Fax:716-626-9193
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016319225100000X
NY021601-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02881029Medicaid
NY4703Medicare PIN