Healthcare Provider Details

I. General information

NPI: 1184698862
Provider Name (Legal Business Name): HEATHER BELANGER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13000 BRUCE B DOWNS BLVD PHYSICAL MEDICINE AND REHABILITATION - 117
TAMPA FL
33612-4745
US

IV. Provider business mailing address

205 W LOUISIANA AVE
TAMPA FL
33603-2015
US

V. Phone/Fax

Practice location:
  • Phone: 813-972-2000
  • Fax:
Mailing address:
  • Phone: 813-234-1579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY6860
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: