Provider Demographics
NPI:1740683739
Name:FENIMORE, HEATHER (DPT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:FENIMORE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1226 CANYON VILLAGE CIR
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1861
Mailing Address - Country:US
Mailing Address - Phone:512-698-6478
Mailing Address - Fax:
Practice Address - Street 1:1226 CANYON VILLAGE CIR
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1861
Practice Address - Country:US
Practice Address - Phone:512-698-6478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40057225100000X
TX1208226225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist