=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609100635
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHANDRA DENISE HEAVEN LPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2009
-----------------------------------------------------
Last Update Date | 10/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2817 ROCK MERRITT AVE WOMACK ARMY MEDICAL CENTER
-----------------------------------------------------
City | FORT BRAGG
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28310-1700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-907-8922
-----------------------------------------------------
Fax | 910-907-6069
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2817 ROCK MERRITT AVE WOMACK ARMY MEDICAL CENTER
-----------------------------------------------------
City | FORT BRAGG
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28310-1700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-907-8922
-----------------------------------------------------
Fax | 910-907-6069
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251X0800X
-----------------------------------------------------
Taxonomy Name | Orthopedic Physical Therapist
-----------------------------------------------------
License Number | P11369
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------