Provider Demographics
NPI:1972624310
Name:ESPELAND, HEATHER D (PHYSICAL THERAPY)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:D
Last Name:ESPELAND
Suffix:
Gender:F
Credentials:PHYSICAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5026 DEEPWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78415-2901
Mailing Address - Country:US
Mailing Address - Phone:361-664-9675
Mailing Address - Fax:361-664-1100
Practice Address - Street 1:2150 W WHEELER AVE
Practice Address - Street 2:
Practice Address - City:ARANSAS PASS
Practice Address - State:TX
Practice Address - Zip Code:78336-4711
Practice Address - Country:US
Practice Address - Phone:361-664-9675
Practice Address - Fax:361-664-1100
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1164689225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1862112-01Medicaid
TX8T6999OtherBLUE CROSS BLUE SHIELD
TXP00472127Medicare PIN
TX8J7401Medicare PIN