Provider Demographics
NPI:1265803035
Name:ROSS, HEATHER HAMILTON (MPT, PHD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:HAMILTON
Last Name:ROSS
Suffix:
Gender:F
Credentials:MPT, PHD
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:RENEE
Other - Last Name:HAMILTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:500 WASHINGTON ST SE
Mailing Address - Street 2:DEPARTMENT OF PHYSICAL THERAPY
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3628
Mailing Address - Country:US
Mailing Address - Phone:678-971-1835
Mailing Address - Fax:
Practice Address - Street 1:301 MAIN ST SW
Practice Address - Street 2:BRENAU DOWNTOWN CENTER
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3777
Practice Address - Country:US
Practice Address - Phone:678-971-1835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT012165225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist