Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 8187 | MN |
NPI | 1003067893 |
---|---|
Provider Name | Mrs. Heather Marie Goutermont |
First Address | Silver Bay, MN 55614-1337 |
Second Address | Silver Bay, MN 55614-1337 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2008 |
Last Update Date | 18/03/2016 |