Provider Demographics
NPI:1790064939
Name:QUIROGA, HEATHER RENEE (PT,DPT)
Entity Type:Individual
Prefix:MISS
First Name:HEATHER
Middle Name:RENEE
Last Name:QUIROGA
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 1:119 RIVERMARSH DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-9463
Mailing Address - Country:US
Mailing Address - Phone:904-993-3216
Mailing Address - Fax:
Practice Address - Street 1:119 RIVERMARSH DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-9463
Practice Address - Country:US
Practice Address - Phone:904-993-3216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-05
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010396225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA116645Medicare PIN