Provider Demographics
NPI:1871788984
Name:BRYANT, HEATHER LUCETTE (PT)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:LUCETTE
Last Name:BRYANT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 728
Mailing Address - Street 2:
Mailing Address - City:MCKENNA
Mailing Address - State:WA
Mailing Address - Zip Code:98558-0728
Mailing Address - Country:US
Mailing Address - Phone:432-638-5077
Mailing Address - Fax:
Practice Address - Street 1:9040 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-5657
Practice Address - Country:US
Practice Address - Phone:253-968-1157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60112611225100000X
TX1091510225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist