Healthcare Provider Details

I. General information

NPI: 1518975804
Provider Name (Legal Business Name): HEATHER MICHELE JEFFCOAT PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13425 VENTURA BLVD STE 200
SHERMAN OAKS CA
91423-3997
US

IV. Provider business mailing address

13425 VENTURA BLVD STE 200
SHERMAN OAKS CA
91423-3997
US

V. Phone/Fax

Practice location:
  • Phone: 818-877-6910
  • Fax: 818-647-0363
Mailing address:
  • Phone: 818-877-6910
  • Fax: 818-647-0363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT29666
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number29666
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: