Provider Demographics
NPI:1134243843
Name:MCCAULLEY, HEALTHER NICOLE (MPT)
Entity type:Individual
Prefix:MRS
First Name:HEALTHER
Middle Name:NICOLE
Last Name:MCCAULLEY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:NICOLE
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:1320 S MINNESOTA AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-0654
Mailing Address - Country:US
Mailing Address - Phone:605-332-2565
Mailing Address - Fax:605-332-2506
Practice Address - Street 1:1320 S MINNESOTA AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-0654
Practice Address - Country:US
Practice Address - Phone:605-332-2565
Practice Address - Fax:605-332-2506
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1142225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist