Provider Demographics
NPI:1770047268
Name:WALDSCHMIDT, HEATHER (MAT, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:WALDSCHMIDT
Suffix:
Gender:F
Credentials:MAT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17011 VISTA BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-4666
Mailing Address - Country:US
Mailing Address - Phone:210-422-0221
Mailing Address - Fax:
Practice Address - Street 1:506 BULLDOG LN
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:TX
Practice Address - Zip Code:78124-1741
Practice Address - Country:US
Practice Address - Phone:830-914-2803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-29
Last Update Date:2022-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXAT86492255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty