Provider Demographics
NPI:1982393013
Name:GRIEVES, HEATHER LEE (DPT,PT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LEE
Last Name:GRIEVES
Suffix:
Gender:F
Credentials:DPT,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5109 REGENCY PARK APTS N
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-5805
Mailing Address - Country:US
Mailing Address - Phone:201-647-3929
Mailing Address - Fax:
Practice Address - Street 1:16 PEARL ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-3648
Practice Address - Country:US
Practice Address - Phone:518-793-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041276261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy