Healthcare Provider Details

I. General information

NPI: 1649380031
Provider Name (Legal Business Name): HEATHER LAFERRIERE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 10/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5350 MANHATTAN CIR SUITE 100
BOULDER CO
80303-4272
US

IV. Provider business mailing address

5350 MANHATTAN CIR SUITE 100
BOULDER CO
80303-4272
US

V. Phone/Fax

Practice location:
  • Phone: 303-543-1201
  • Fax: 303-543-1206
Mailing address:
  • Phone: 303-543-1201
  • Fax: 303-543-1206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier007406
Identifier TypeOTHER
Identifier StateCT
Identifier IssuerLICENSE#
# 2
Identifier10172
Identifier TypeOTHER
Identifier StateCO
Identifier IssuerPT LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: