Provider Demographics
NPI:1225690084
Name:HEATH, BARRY JAMES (PTA)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:JAMES
Last Name:HEATH
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 CAMDEN ST STE 107
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04841-2458
Mailing Address - Country:US
Mailing Address - Phone:207-596-0133
Mailing Address - Fax:
Practice Address - Street 1:91 CAMDEN ST STE 107
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841-2458
Practice Address - Country:US
Practice Address - Phone:207-596-0133
Practice Address - Fax:207-596-0144
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA4930225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant