Provider Demographics
NPI:1669733390
Name:BOYETTE, HEATHER NICOLE (PTA)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:NICOLE
Last Name:BOYETTE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:NICOLE
Other - Last Name:DELASALLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 PIN OAK DR
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-9006
Mailing Address - Country:US
Mailing Address - Phone:601-807-9277
Mailing Address - Fax:
Practice Address - Street 1:344 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-3551
Practice Address - Country:US
Practice Address - Phone:601-443-2344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-29
Last Update Date:2025-07-21
Deactivation Date:2025-05-29
Deactivation Code:
Reactivation Date:2025-07-21
Provider Licenses
StateLicense IDTaxonomies
MSPTA4741225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant