Provider Demographics
NPI:1700823739
Name:CLINES, HEATHER C (MPT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:C
Last Name:CLINES
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1868 PLAUDIT PL STE B
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2429
Mailing Address - Country:US
Mailing Address - Phone:859-264-0512
Mailing Address - Fax:859-264-0595
Practice Address - Street 1:171 N KEENELAND DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-8687
Practice Address - Country:US
Practice Address - Phone:595-751-8888
Practice Address - Fax:859-575-4121
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT004655225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist