Provider Demographics
NPI:1023251543
Name:BURNS, HEATHER L (LMT)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:L
Last Name:BURNS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:L
Other - Last Name:SPENCER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:4510 COLLINS BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-6954
Mailing Address - Country:US
Mailing Address - Phone:440-997-0014
Mailing Address - Fax:440-998-7032
Practice Address - Street 1:4510 COLLINS BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-6954
Practice Address - Country:US
Practice Address - Phone:440-997-0014
Practice Address - Fax:440-998-7032
Is Sole Proprietor?:No
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.016868172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist