Provider Demographics
NPI:1831592880
Name:CONWAY, HEATHER (PTA)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:CONWAY
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 1:101 ADIRONDACK DR STE 1
Mailing Address - Street 2:
Mailing Address - City:TICONDEROGA
Mailing Address - State:NY
Mailing Address - Zip Code:12883-9334
Mailing Address - Country:US
Mailing Address - Phone:518-585-3810
Mailing Address - Fax:518-585-3822
Practice Address - Street 1:101 ADIRONDACK DR STE 1
Practice Address - Street 2:
Practice Address - City:TICONDEROGA
Practice Address - State:NY
Practice Address - Zip Code:12883-9334
Practice Address - Country:US
Practice Address - Phone:518-585-3810
Practice Address - Fax:518-585-3822
Is Sole Proprietor?:No
Enumeration Date:2014-10-06
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004905-1225200000X
NY004905-01225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant