Provider Demographics
NPI:1255346672
Name:REEVES, HEATHER B (RPT)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:B
Last Name:REEVES
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 MALLET HILL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-4406
Mailing Address - Country:US
Mailing Address - Phone:803-661-8522
Mailing Address - Fax:803-419-6992
Practice Address - Street 1:810 MALLET HILL RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-4406
Practice Address - Country:US
Practice Address - Phone:803-661-8522
Practice Address - Fax:803-419-6992
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4266PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ06270Medicare UPIN