Provider Demographics
NPI:1801053533
Name:JETT, HEATHER ELIZABETH
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:ELIZABETH
Last Name:JETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 E ALOSTA AVE APT 292
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-2755
Mailing Address - Country:US
Mailing Address - Phone:310-722-8628
Mailing Address - Fax:
Practice Address - Street 1:902 S. MYRTLE AVE
Practice Address - Street 2:PACIFIC CLINICS
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-3427
Practice Address - Country:US
Practice Address - Phone:626-358-8964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner