Individual
JAMES HEETER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1431 SOUTHWEST BLVD, JEFFERSON CITY, MO 65109-2468
(573) 636-9104
Mailing address
7201 E BASS LN, COLUMBIA, MO 65201-8902
(573) 441-8541
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00995
LICENSE#
MO
Enumeration date
11/02/2006
Last updated
07/08/2007
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