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General NPI Number Information
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NPI Number | 1154655066
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Entity Type | Individual
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Provider Name | HEATHER DENSMORE P.T.
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Gender | Female
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Dates
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Enumeration Date | 09/24/2009
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Last Update Date | 07/20/2015
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Provider Practice Location Address
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Address Line | 136 FAIRVIEW RD SUITE 110
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City | MOORESVILLE
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State | NC
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Zip | 28117-9517
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Country | US
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Telephone | 704-799-4611
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4570
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City | DAVIDSON
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State | NC
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Zip | 28036-4570
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Country | US
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Telephone | 704-819-6910
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 8070
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License Number State | NC
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