Provider Demographics
NPI:1962060855
Name:MOORE, HEATHER RAE (DPT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:RAE
Last Name:MOORE
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 1:55 CENTRAL IOWA DR
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-4705
Mailing Address - Country:US
Mailing Address - Phone:641-754-6120
Mailing Address - Fax:641-854-8205
Practice Address - Street 1:55 CENTRAL IOWA DR
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-4705
Practice Address - Country:US
Practice Address - Phone:641-754-6120
Practice Address - Fax:641-854-8205
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2304225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1215327283OtherCLINIC NPI