Provider Demographics
NPI:1922396811
Name:CROOK, HEATHER EDWARDS (MPT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:EDWARDS
Last Name:CROOK
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 SABER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-6056
Mailing Address - Country:US
Mailing Address - Phone:719-387-4888
Mailing Address - Fax:
Practice Address - Street 1:15 S WEBER ST STE A
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1920
Practice Address - Country:US
Practice Address - Phone:719-630-7774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO113242251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic