Provider Demographics
NPI:1548892607
Name:HAMAGUCHI, HEATHER G (PT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:G
Last Name:HAMAGUCHI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:211 TANK FARM RD
Mailing Address - Street 2:STE A
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7509
Mailing Address - Country:US
Mailing Address - Phone:805-439-3900
Mailing Address - Fax:805-439-3901
Practice Address - Street 1:1510 W BRANCH ST
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-1817
Practice Address - Country:US
Practice Address - Phone:805-489-7912
Practice Address - Fax:805-489-9697
Is Sole Proprietor?:No
Enumeration Date:2020-02-06
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT298080225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist