Provider Demographics
NPI:1679536569
Name:HEESPELINK, NUALA A (PT)
Entity Type:Individual
Prefix:
First Name:NUALA
Middle Name:A
Last Name:HEESPELINK
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 1:291 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-3628
Mailing Address - Country:US
Mailing Address - Phone:617-972-5255
Mailing Address - Fax:617-541-6312
Practice Address - Street 1:291 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-3628
Practice Address - Country:US
Practice Address - Phone:617-972-5255
Practice Address - Fax:617-541-6312
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9707225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB501027OtherCIGNA
MAB372OtherHARVARD PILGRIM
MAY67446OtherBLUE CROSS
MA0014471OtherNEIGHBORHOOD HEALTH PLAN
MA0309851Medicaid
MAY68259Medicare ID - Type Unspecified