Provider Demographics
NPI:1639530702
Name:LAW, HEATHER CHRISTINE (PT, DPT, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:CHRISTINE
Last Name:LAW
Suffix:
Gender:F
Credentials:PT, DPT, ATC, LAT
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:CHRISTINE
Other - Last Name:FARISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, ATC, LAT
Mailing Address - Street 1:3090 N 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4402
Mailing Address - Country:US
Mailing Address - Phone:602-745-2939
Mailing Address - Fax:602-745-2962
Practice Address - Street 1:3090 N 3RD AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4402
Practice Address - Country:US
Practice Address - Phone:602-745-2939
Practice Address - Fax:602-745-2963
Is Sole Proprietor?:No
Enumeration Date:2016-03-16
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1271261225100000X
AZLPT-012927225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ311736Medicaid