Provider Demographics
NPI:1912159955
Name:BUONOCORE, HEATHER LEANNE (PT)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:LEANNE
Last Name:BUONOCORE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:LEANNE
Other - Last Name:HAINES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:130 FREDERICKSBURG DRIVE
Mailing Address - Street 2:
Mailing Address - City:STEPHENS CITY
Mailing Address - State:VA
Mailing Address - Zip Code:22655-4542
Mailing Address - Country:US
Mailing Address - Phone:540-868-0408
Mailing Address - Fax:540-868-0408
Practice Address - Street 1:130 FREDERICKSBURG DRIVE
Practice Address - Street 2:
Practice Address - City:STEPHENS CITY
Practice Address - State:VA
Practice Address - Zip Code:22655-4542
Practice Address - Country:US
Practice Address - Phone:540-868-0408
Practice Address - Fax:540-868-0408
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305004456225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist