Provider Demographics
NPI:1750449666
Name:FORD, HEATHER BROOKE (PT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:BROOKE
Last Name:FORD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:BROOKE
Other - Last Name:LAWSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:99 MONTECILLO RD
Mailing Address - Street 2:MOB 2 - PHYSICAL THERAPY DEPT
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-3308
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:99 MONTECILLO RD
Practice Address - Street 2:MOB 2 - PHYSICAL THERAPY DEPT
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-3308
Practice Address - Country:US
Practice Address - Phone:415-444-2962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 24690225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist