Provider Demographics
NPI:1215265459
Name:HARKNESS, HEATHER BROOKS (PTA)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:BROOKS
Last Name:HARKNESS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12943 OLD BONITA RD
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71220-8460
Mailing Address - Country:US
Mailing Address - Phone:318-282-7315
Mailing Address - Fax:
Practice Address - Street 1:2601 FERRAND ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3212
Practice Address - Country:US
Practice Address - Phone:318-387-4973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA7648225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant