Provider Demographics
NPI:1316344773
Name:CRONK, HEATHER NOELLE (PTA)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:NOELLE
Last Name:CRONK
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 1:2693 E WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-1412
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:595 E WASHINGTON BLVD
Practice Address - Street 2:APPT D
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-2264
Practice Address - Country:US
Practice Address - Phone:626-345-4243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10232225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant