Provider Demographics
NPI:1720143829
Name:FURNISS, HEATHER (MPT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:FURNISS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3026 HIDDEN LAKE PT
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-4455
Mailing Address - Country:US
Mailing Address - Phone:270-685-9499
Mailing Address - Fax:270-685-9443
Practice Address - Street 1:604 E ILLINOIS STREET
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47567-8043
Practice Address - Country:US
Practice Address - Phone:812-885-2364
Practice Address - Fax:270-685-9443
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007835A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist