Provider Demographics
NPI:1427080696
Name:DURRETT, HEATHER JANE (MPT)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:JANE
Last Name:DURRETT
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:JANE
Other - Last Name:KNUDSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:11441 DANCING RIVER DR
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-4127
Mailing Address - Country:US
Mailing Address - Phone:941-493-6979
Mailing Address - Fax:941-484-5487
Practice Address - Street 1:13638 2ND AVE NE
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34212-2725
Practice Address - Country:US
Practice Address - Phone:941-228-6734
Practice Address - Fax:941-343-9402
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT18718225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY8758OtherBLUE CROSS BLUE SHIELD