Provider Demographics
NPI:1760688931
Name:GEYER, HEATHER ELYSE (MSPT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ELYSE
Last Name:GEYER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:ELYSE
Other - Last Name:FERRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2440 GOLD STAR HWY SUITE 201
Mailing Address - Street 2:INDEPENDENCE PHYSICAL THERAPY LLC
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355
Mailing Address - Country:US
Mailing Address - Phone:860-536-1001
Mailing Address - Fax:860-536-1005
Practice Address - Street 1:2440 GOLD STAR HWY SUITE 201
Practice Address - Street 2:
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355
Practice Address - Country:US
Practice Address - Phone:860-536-1001
Practice Address - Fax:860-536-1005
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist