Individual
MRS. HEATHER ELIZABETH MCCORMACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
315 EAST WALNUT, ELLINGTON, MO 63638-0580
(573) 663-2500
Mailing address
PO BOX 580, ELLINGTON, MO 63638-0580
(573) 663-2500
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2007023619
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1700026432
—
MO
Enumeration date
02/20/2009
Last updated
10/23/2009
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