Provider Demographics
NPI:1699340810
Name:AHMADZAI, HEATHER LAUREN (DPT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LAUREN
Last Name:AHMADZAI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 SHASTA DAISY DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-6382
Mailing Address - Country:US
Mailing Address - Phone:925-813-0586
Mailing Address - Fax:
Practice Address - Street 1:822 SHASTA DAISY DR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-6382
Practice Address - Country:US
Practice Address - Phone:925-813-0586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-20
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA299107225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist