Provider Demographics
NPI:1861233454
Name:MCCROCKLIN, HEATHER E (PTA)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:E
Last Name:MCCROCKLIN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2967 OAK RUN PKWY STE 505
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132-5454
Mailing Address - Country:US
Mailing Address - Phone:830-837-2777
Mailing Address - Fax:
Practice Address - Street 1:2967 OAK RUN PKWY STE 505
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78132-5454
Practice Address - Country:US
Practice Address - Phone:830-837-2777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2177731225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant