Provider Demographics
NPI:1770668147
Name:HEISEY, JANET LAURA (PT)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:LAURA
Last Name:HEISEY
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 1:9 DAMONMILL SQ
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2858
Mailing Address - Country:US
Mailing Address - Phone:978-369-9996
Mailing Address - Fax:978-371-2516
Practice Address - Street 1:9 DAMONMILL SQ
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2858
Practice Address - Country:US
Practice Address - Phone:978-369-9996
Practice Address - Fax:978-371-2516
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6731225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MABRY 68291Medicare ID - Type Unspecified