Healthcare Provider Details

I. General information

NPI: 1699773713
Provider Name (Legal Business Name): HEATHER M WITHERS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: HEATHER WHITE PT

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 PARK ST
PASO ROBLES CA
93446-2160
US

IV. Provider business mailing address

1414 PARK ST
PASO ROBLES CA
93446-2160
US

V. Phone/Fax

Practice location:
  • Phone: 805-237-0272
  • Fax: 805-237-2416
Mailing address:
  • Phone: 805-237-0272
  • Fax: 805-237-2416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT25511
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: