Provider Demographics
NPI:1306121306
Name:HEATHMAN, JANET (PT)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:HEATHMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:BLOMGREN
Other - Last Name:HEATHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:36919 COOK ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-6069
Mailing Address - Country:US
Mailing Address - Phone:760-340-3255
Mailing Address - Fax:760-452-5335
Practice Address - Street 1:36919 COOK ST
Practice Address - Street 2:SUITE 102
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-6069
Practice Address - Country:US
Practice Address - Phone:760-340-3255
Practice Address - Fax:760-452-5335
Is Sole Proprietor?:No
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18980225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist