Basic Information
| Provider Information | |||||||||
| NPI: | 1528178597 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOOD | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | RIMER | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 661495 | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352661495 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059795882 | ||||||||
| FaxNumber: | 2059791248 | ||||||||
| Practice Location | |||||||||
| Address1: | 1310 ALFORD AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | HOOVER | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352263199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2058248850 | ||||||||
| FaxNumber: | 2058248853 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 18269 | AL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 515-25774 | 01 | AL | BLUE CROSS PROVIDER NUMBE | OTHER | 7498678 | 01 | AL | AETNA | OTHER |