Provider Demographics
NPI:1972739449
Name:DODGE HASSELSCHWERT, HEATHER DIANE (DPT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:DIANE
Last Name:DODGE HASSELSCHWERT
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 1:1010 SW COAST HWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-5288
Mailing Address - Country:US
Mailing Address - Phone:541-265-4252
Mailing Address - Fax:541-265-8914
Practice Address - Street 1:1010 SW COAST HWY
Practice Address - Street 2:SUITE 102
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-5288
Practice Address - Country:US
Practice Address - Phone:541-265-4252
Practice Address - Fax:541-265-8914
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-10
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5955225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist