Healthcare Provider Details

I. General information

NPI: 1427080696
Provider Name (Legal Business Name): HEATHER JANE DURRETT M.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER JANE KNUDSEN P.T.

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13638 2ND AVE NE
BRADENTON FL
34212-2725
US

IV. Provider business mailing address

11441 DANCING RIVER DR
VENICE FL
34292-4127
US

V. Phone/Fax

Practice location:
  • Phone: 941-228-6734
  • Fax: 941-343-9402
Mailing address:
  • Phone: 941-493-6979
  • Fax: 941-484-5487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT18718
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: