Healthcare Provider Details

I. General information

NPI: 1306386024
Provider Name (Legal Business Name): HEATHER FINN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEATHER MILKOWSKI

II. Dates (important events)

Enumeration Date: 02/28/2017
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 SOUTHERN JUNCTION BLVD
POOLER GA
31322-2214
US

IV. Provider business mailing address

34 WISTERIA DR
FORT STEWART GA
31315-2827
US

V. Phone/Fax

Practice location:
  • Phone: 254-423-6046
  • Fax:
Mailing address:
  • Phone: 254-423-6046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA003723
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2079220
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: