Provider Demographics
NPI:1093099285
Name:GREAM, HEATHER (DPT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:GREAM
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6003 PLEASANT COLONY CT
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-8678
Mailing Address - Country:US
Mailing Address - Phone:502-241-5597
Mailing Address - Fax:502-241-6499
Practice Address - Street 1:6003 PLEASANT COLONY CT
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:KY
Practice Address - Zip Code:40014-8678
Practice Address - Country:US
Practice Address - Phone:502-241-5597
Practice Address - Fax:502-241-6499
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY005888225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist