Provider Demographics
NPI:1134466014
Name:NILES, HEIDI L (DPT)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:L
Last Name:NILES
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:PO BOX 19
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04429-0019
Mailing Address - Country:US
Mailing Address - Phone:207-907-0744
Mailing Address - Fax:207-800-4960
Practice Address - Street 1:17 2ND ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6133
Practice Address - Country:US
Practice Address - Phone:207-907-0744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT28040225100000X
NC13837225100000X
MEPT3963225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist