Provider Demographics
NPI:1255760930
Name:GIRGES, HEATHER (PT, DPT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:GIRGES
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:MICKEAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1931 BLACK ROCK TPKE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-3506
Mailing Address - Country:US
Mailing Address - Phone:203-384-8681
Mailing Address - Fax:203-384-0722
Practice Address - Street 1:555 BRIDGEPORT AVE STE 1
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-4731
Practice Address - Country:US
Practice Address - Phone:203-922-1773
Practice Address - Fax:203-924-2334
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01521000225100000X
CT11599225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist