Provider Demographics
NPI:1780782631
Name:AVERETT, HEATHER (PTA)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:
Last Name:AVERETT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 PRINCETON BLVD
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01851-2405
Mailing Address - Country:US
Mailing Address - Phone:978-454-8086
Mailing Address - Fax:
Practice Address - Street 1:30 PRINCETON BLVD
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01851-2405
Practice Address - Country:US
Practice Address - Phone:978-454-8086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8004225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant