Provider Demographics
NPI:1457832982
Name:FUSCO, HEATHER (PTA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:FUSCO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 STILES RD STE 203
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-4804
Mailing Address - Country:US
Mailing Address - Phone:855-390-7774
Mailing Address - Fax:
Practice Address - Street 1:1 STILES RD STE 203
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-4804
Practice Address - Country:US
Practice Address - Phone:855-390-7774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2806225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant