Provider Demographics
NPI:1992018915
Name:HELLER, MARISSA JONI (DPT)
Entity Type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:JONI
Last Name:HELLER
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 1:401 MOUNT VERNON ST APT 724
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02125-3150
Mailing Address - Country:US
Mailing Address - Phone:914-584-5683
Mailing Address - Fax:
Practice Address - Street 1:10J GILL ST
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-1721
Practice Address - Country:US
Practice Address - Phone:781-932-2888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19108225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist