Provider Demographics
NPI:1972782365
Name:HEATON, NORA JEAN (PT)
Entity Type:Individual
Prefix:
First Name:NORA
Middle Name:JEAN
Last Name:HEATON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 S 333RD ST
Mailing Address - Street 2:STE 250
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-7363
Mailing Address - Country:US
Mailing Address - Phone:253-874-2998
Mailing Address - Fax:253-874-3307
Practice Address - Street 1:13050 MILITARY RD S
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-3047
Practice Address - Country:US
Practice Address - Phone:206-248-3080
Practice Address - Fax:206-248-4242
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010767225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00704705OtherRR MEDICARE
WA1972782365Medicaid
WA1972782365Medicaid