Provider Demographics
NPI:1780079871
Name:SANTOS, HEATHER WHITE (PT, DPT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:WHITE
Last Name:SANTOS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:BISHOP
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT,DPT
Mailing Address - Street 1:855 N MAIN RD
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02835-1734
Mailing Address - Country:US
Mailing Address - Phone:603-616-3535
Mailing Address - Fax:
Practice Address - Street 1:855 N MAIN RD
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:RI
Practice Address - Zip Code:02835-1734
Practice Address - Country:US
Practice Address - Phone:603-616-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-06
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT02482225100000X
MA20955225100000X
NH3894225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist