Provider Demographics
NPI:1104915644
Name:COSTAS, HEATHER RENEE (MSPT, CIMT)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:RENEE
Last Name:COSTAS
Suffix:
Gender:F
Credentials:MSPT, CIMT
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:RENEE
Other - Last Name:DELANEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT, CIMT
Mailing Address - Street 1:33900 HARPER AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4258
Mailing Address - Country:US
Mailing Address - Phone:586-416-9100
Mailing Address - Fax:528-416-9103
Practice Address - Street 1:50174 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48315-3136
Practice Address - Country:US
Practice Address - Phone:586-884-5040
Practice Address - Fax:586-580-0375
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011833225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist