| Doctor Name: | HEATHER D'AGOSTA |
| NPI Number: | 1194967364 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 5501014343 |
| Business Practice Address: | 3145 W Clark Rd Ste 102 Ypsilanti, MI - 481971120 |
| Business Phone Number: | 7345289760 |
| Business Fax Number: | 7348290173 |
| Mailing Address: | 790 Remington Blvd, BOLINGBROOK |
| State: | IL |
| Postal Code: | 604404909 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 04/02/2009 |
| NPI Last Update Date: | 04/09/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 5501014343 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |