Provider Demographics
NPI:1659525012
Name:COONEY, HEATHER R (RADT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:R
Last Name:COONEY
Suffix:
Gender:X
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1183 W METZ RD
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92570-1727
Mailing Address - Country:US
Mailing Address - Phone:951-333-7581
Mailing Address - Fax:
Practice Address - Street 1:31946 MISSION TRL STE B
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-4539
Practice Address - Country:US
Practice Address - Phone:951-333-7581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-12
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225400000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No171M00000XOther Service ProvidersCase Manager/Care Coordinator