Provider Demographics
NPI:1508823345
Name:ANDERSON, HEATHER BEAL (DPT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:BEAL
Last Name:ANDERSON
Suffix:
Gender:F
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:P.O. BOX 220
Mailing Address - Street 2:1110 MAIN ST.
Mailing Address - City:HARRINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04643-0220
Mailing Address - Country:US
Mailing Address - Phone:204-483-4022
Mailing Address - Fax:207-483-9722
Practice Address - Street 1:1110 MAIN ST.
Practice Address - Street 2:
Practice Address - City:HARRINGTON
Practice Address - State:ME
Practice Address - Zip Code:04643-0220
Practice Address - Country:US
Practice Address - Phone:204-483-4022
Practice Address - Fax:207-483-9722
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT2403225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME022310OtherANTHEM BC
ME189660000Medicaid
ME022310OtherANTHEM BC