Provider Demographics
NPI:1730641325
Name:HEUCHERT, MARY BERAN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:BERAN
Last Name:HEUCHERT
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6147 SHAKESPEARE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-2920
Mailing Address - Country:US
Mailing Address - Phone:225-603-9138
Mailing Address - Fax:
Practice Address - Street 1:6147 SHAKESPEARE DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-2920
Practice Address - Country:US
Practice Address - Phone:225-603-9138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA014112251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
01411OtherPART C