Basic Information
| Provider Information | |||||||||
| NPI: | 1063790103 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAMAN | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | MICHELLE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 135 GOSHEN ROAD EXT | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | RINCON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 313265567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8778261509 | ||||||||
| FaxNumber: | 9128269767 | ||||||||
| Practice Location | |||||||||
| Address1: | 2451 US HIGHWAY 17 | ||||||||
| Address2: | SUITE B | ||||||||
| City: | RICHMOND HILL | ||||||||
| State: | GA | ||||||||
| PostalCode: | 313243397 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9124592230 | ||||||||
| FaxNumber: | 9124592240 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2011 | ||||||||
| LastUpdateDate: | 01/24/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT010155 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.