Provider Demographics
NPI:1871803783
Name:SHAUGHNESSY, HEATHER NICOLE (DPT)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:NICOLE
Last Name:SHAUGHNESSY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:NICOLE
Other - Last Name:BERUBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:57 MOUNTAIN MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-6597
Mailing Address - Country:US
Mailing Address - Phone:406-272-5800
Mailing Address - Fax:
Practice Address - Street 1:112 E BLANCHARD LAKE RD
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-8466
Practice Address - Country:US
Practice Address - Phone:406-272-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-13
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT24537225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist