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General NPI Number Information
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NPI Number | 1659525012
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Entity Type | Individual
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Provider Name | HEATHER R COONEY RADT
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Gender |
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Dates
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Enumeration Date | 11/12/2008
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Last Update Date | 05/21/2024
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Provider Practice Location Address
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Address Line | 31946 MISSION TRL STE B
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City | LAKE ELSINORE
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State | CA
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Zip | 92530-4539
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Country | US
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Telephone | 951-333-7581
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Fax |
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Provider Business Mailing Address
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Address Line | 1183 W METZ RD
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City | PERRIS
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State | CA
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Zip | 92570-1727
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Country | US
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Telephone | 951-333-7581
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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 | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | CA
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