Provider Demographics
NPI:1982887345
Name:LA MANNO, HEATHER (DPT)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:
Last Name:LA MANNO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 NEWARK POMPTON TPKE
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07457-1426
Mailing Address - Country:US
Mailing Address - Phone:973-248-8111
Mailing Address - Fax:973-248-8113
Practice Address - Street 1:69 NEWARK POMPTON TPKE
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:NJ
Practice Address - Zip Code:07457-1426
Practice Address - Country:US
Practice Address - Phone:973-248-8111
Practice Address - Fax:973-248-8113
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-07
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01260200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist