Provider Demographics
NPI:1861749954
Name:STEVENSON, HEATHER MARIETTE (PT)
Entity type:Individual
Prefix:MISS
First Name:HEATHER
Middle Name:MARIETTE
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:MILNE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:7903 170TH PL NE APT S104
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-4432
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:8630 164TH AVE NE # 203
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3606
Practice Address - Country:US
Practice Address - Phone:425-658-4980
Practice Address - Fax:425-658-4977
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400086024225100000X
WAPT60392658225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1861749954Medicaid
WAP01276067OtherMEDICARE RAILROAD
WA0316277OtherDEPT. OF LABOR AND INDUSTRIES
WAP01276067OtherMEDICARE RAILROAD