Provider Demographics
NPI:1083912661
Name:HICETA, HEIDI (PT)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:
Last Name:HICETA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 MOUNTAIN ALDER LN
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-9235
Mailing Address - Country:US
Mailing Address - Phone:828-318-3101
Mailing Address - Fax:
Practice Address - Street 1:314 MOUNTAIN ALDER LN
Practice Address - Street 2:
Practice Address - City:FLETCHER
Practice Address - State:NC
Practice Address - Zip Code:28732-9235
Practice Address - Country:US
Practice Address - Phone:828-318-3101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP11401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist