Individual
HEATHER R KONTOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
2465 CANOPY GLN, MARIETTA, GA 30066-1541
(770) 517-2480
(770) 592-9431
Mailing address
PO BOX 670207, MARIETTA, GA 30066-0121
(770) 517-2480
(770) 592-9431
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
5276
GA
2251P0200X
Pediatric Physical Therapist
Primary
5276
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10040364
AMERIGROUP
GA
01
—
318312
WELLCARE
GA
01
—
5276
PHYSICAL THERAPY LICENSE
GA
Enumeration date
12/11/2006
Last updated
09/11/2025
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