Provider Demographics
NPI:1659424752
Name:DECORDOVA, HEATHER MARIE (MPT, OCS)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:DECORDOVA
Suffix:
Gender:F
Credentials:MPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:23206 AGRAMONTE DR
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-3502
Mailing Address - Country:US
Mailing Address - Phone:661-254-8727
Mailing Address - Fax:661-253-8351
Practice Address - Street 1:23845 MCBEAN PKWY
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-2001
Practice Address - Country:US
Practice Address - Phone:661-253-8959
Practice Address - Fax:661-253-8351
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT171272251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic