Provider Demographics
NPI:1134163835
Name:CRACOWER, HEATHER J (PT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:J
Last Name:CRACOWER
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 1:20 KILBURN ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-4720
Mailing Address - Country:US
Mailing Address - Phone:802-864-9643
Mailing Address - Fax:802-864-9643
Practice Address - Street 1:20 KILBURN ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4720
Practice Address - Country:US
Practice Address - Phone:802-864-9643
Practice Address - Fax:802-864-9643
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040-0003627225100000X
WA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist