Provider Demographics
NPI:1679022123
Name:BITGOOD, HEATHER A (PT, DPT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:A
Last Name:BITGOOD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 E BOGARD RD
Mailing Address - Street 2:B-203
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-6533
Mailing Address - Country:US
Mailing Address - Phone:907-376-4325
Mailing Address - Fax:907-376-2365
Practice Address - Street 1:1700 E BOGARD RD
Practice Address - Street 2:B-203
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-6533
Practice Address - Country:US
Practice Address - Phone:907-376-4325
Practice Address - Fax:907-376-2365
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-26
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR61478225100000X
AZ11011225100000X
NY037144225100000X
COPTL.0014076225100000X
CA41872225100000X
AK108403225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist