Healthcare Provider Details

I. General information

NPI: 1063914646
Provider Name (Legal Business Name): HEATHER HEPPER PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 07/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10483 DIXIE HWY
HOLLY MI
48442
US

IV. Provider business mailing address

1605 E 13 MILE RD APT 302
MADISON HEIGHTS MI
48071-5019
US

V. Phone/Fax

Practice location:
  • Phone: 810-771-7686
  • Fax: 810-771-7685
Mailing address:
  • Phone: 989-245-0539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: