Provider Demographics
NPI:1902173834
Name:LANDERS, HEATHER MARIE (ATC/PTA)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:MARIE
Last Name:LANDERS
Suffix:
Gender:F
Credentials:ATC/PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2575 CHAD DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72405-8189
Mailing Address - Country:US
Mailing Address - Phone:870-403-2214
Mailing Address - Fax:
Practice Address - Street 1:2575 CHAD DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72405-8189
Practice Address - Country:US
Practice Address - Phone:870-403-2214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-21
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA4349225200000X
ARAT4502255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant