Provider Demographics
NPI:1639391014
Name:DAVID, HEATHER MARIE SCOTT (MPT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE SCOTT
Last Name:DAVID
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:MARIE
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4448 MOUNT HERBERT AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-4730
Mailing Address - Country:US
Mailing Address - Phone:858-752-7754
Mailing Address - Fax:
Practice Address - Street 1:700 WINDY POINT DR
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-1701
Practice Address - Country:US
Practice Address - Phone:858-752-7754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28658225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist