Provider Demographics
NPI:1851594105
Name:MARGO, HEATHER RAE (MPT)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:RAE
Last Name:MARGO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:RAE
Other - Last Name:HOFFMAN
Other - Suffix:I
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:2101 GREENTREE RD
Mailing Address - Street 2:SUITE A116
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15220-1400
Mailing Address - Country:US
Mailing Address - Phone:412-276-8644
Mailing Address - Fax:412-276-8648
Practice Address - Street 1:2101 GREENTREE RD
Practice Address - Street 2:SUITE A116
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15220-1400
Practice Address - Country:US
Practice Address - Phone:412-276-8644
Practice Address - Fax:412-276-8648
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT013735L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA396677Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER