Provider Demographics
NPI:1376841775
Name:ELLEN NOBLE HECKERD PT MS PC
Entity Type:Organization
Organization Name:ELLEN NOBLE HECKERD PT MS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:NOBLE
Authorized Official - Last Name:HECKERD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:207-236-3605
Mailing Address - Street 1:87 ELM ST STE 211
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04843-1959
Mailing Address - Country:US
Mailing Address - Phone:207-236-3605
Mailing Address - Fax:207-230-0323
Practice Address - Street 1:14 RAWSON AVE
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:ME
Practice Address - Zip Code:04843-1830
Practice Address - Country:US
Practice Address - Phone:207-236-3605
Practice Address - Fax:207-230-0323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-09
Last Update Date:2016-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT1472261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy