Heather Elizabeth McCormack, PT
Individual provider Active NPI Physical Therapist · Ellington, MO
NPI 1700026432 · NPPES record last updated Oct 23, 2009
Key facts
- NPI
- 1700026432
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 2007023619 (MO)
- Practice address
- 315 East Walnut
Ellington, MO 63638-0580 - Phone
- (573) 663-2500
- NPI assigned
- Feb 20, 2009
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2007023619 | MO | Yes |
Addresses
Primary practice location
315 East Walnut
Ellington, MO 63638-0580
Mailing address
PO Box 580
Ellington, MO 63638-0580
Phone (573) 663-2500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700026432 | Medicaid | MO |
Other providers in Ellington, MO
- Thelma Nicole Lee
- Gwyndolen Ann Loyd
- Amy Lee Manning
- Kristi Lyn Martin
- Jeanie Larue McClanahan
- Tonya Lynn Meade
- Medley Pharmacy Inc.
- Meramec Emergency Physicians, LLP
- Rachel E Morris
- Shawna Renee Myers
All providers in Ellington, MO · Physical Therapist in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 23, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.