Provider Demographics
NPI:1700939253
Name:REPAC, HEATHER SUE (PT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:SUE
Last Name:REPAC
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:SUE
Other - Last Name:WATTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1233 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-0127
Mailing Address - Country:US
Mailing Address - Phone:406-238-6400
Mailing Address - Fax:
Practice Address - Street 1:50 27TH ST W
Practice Address - Street 2:SUITE B
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-8601
Practice Address - Country:US
Practice Address - Phone:406-651-9099
Practice Address - Fax:406-651-4332
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT960PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT60658OtherBCBS
MT346834Medicaid
MT60658OtherBCBS