Provider Demographics
NPI:1821267279
Name:DUSTIN, HEATHER D (PT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:D
Last Name:DUSTIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:DANIELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:141 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-4219
Mailing Address - Country:US
Mailing Address - Phone:203-386-1321
Mailing Address - Fax:
Practice Address - Street 1:217 WOLFPIT RD
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-3426
Practice Address - Country:US
Practice Address - Phone:203-762-8678
Practice Address - Fax:203-761-1570
Is Sole Proprietor?:No
Enumeration Date:2008-02-29
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008083225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist