Provider Demographics
NPI:1801008297
Name:CARPENTER, HEATHER D (PT)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:D
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:D'AUNNO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27 LAZARUS DR
Mailing Address - Street 2:
Mailing Address - City:LEDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07852-2335
Mailing Address - Country:US
Mailing Address - Phone:973-886-5049
Mailing Address - Fax:
Practice Address - Street 1:1139 HAMBURG TPKE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-5055
Practice Address - Country:US
Practice Address - Phone:973-315-5045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006409225100000X
NJ40QA00835000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist