Provider Demographics
NPI:1902012560
Name:WALENGA, HEATHER LOUISE (DPT)
Entity Type:Individual
Prefix:MISS
First Name:HEATHER
Middle Name:LOUISE
Last Name:WALENGA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 MAXIM LN
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-1018
Mailing Address - Country:US
Mailing Address - Phone:312-771-2271
Mailing Address - Fax:
Practice Address - Street 1:9101 2ND AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-2152
Practice Address - Country:US
Practice Address - Phone:301-588-4455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21185225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist