Provider Demographics
NPI:1588789911
Name:CHICHESTER, HEIDI L (PT)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:L
Last Name:CHICHESTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2590 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-7909
Mailing Address - Country:US
Mailing Address - Phone:678-667-3893
Mailing Address - Fax:678-303-9388
Practice Address - Street 1:2590 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-7909
Practice Address - Country:US
Practice Address - Phone:678-667-3893
Practice Address - Fax:678-303-9388
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0067282083P0500X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine