Provider Demographics
NPI:1205129368
Name:WATTER, HEATHER A (DPT)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:A
Last Name:WATTER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 MUSGROVE ROAD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-5223
Mailing Address - Country:US
Mailing Address - Phone:301-989-9040
Mailing Address - Fax:301-989-0939
Practice Address - Street 1:2415 MUSGROVE ROAD
Practice Address - Street 2:SUITE 303
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-5223
Practice Address - Country:US
Practice Address - Phone:301-989-9040
Practice Address - Fax:301-989-0939
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11685-024225100000X
MD23780225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist