Provider Demographics
NPI:1073989455
Name:HEATH, ERIC (DPT)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:HEATH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 S MAIN ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-5261
Mailing Address - Country:US
Mailing Address - Phone:781-961-3370
Mailing Address - Fax:
Practice Address - Street 1:141 LONGWATER DR
Practice Address - Street 2:SUITE 109
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1632
Practice Address - Country:US
Practice Address - Phone:339-788-9202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21887225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist