Provider Demographics
NPI:1184238784
Name:HEISTER, NORA MARIE (PTA)
Entity type:Individual
Prefix:
First Name:NORA
Middle Name:MARIE
Last Name:HEISTER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:NORA
Other - Middle Name:MARIE
Other - Last Name:HAHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2491 RAYSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:PA
Mailing Address - Zip Code:15537-4959
Mailing Address - Country:US
Mailing Address - Phone:814-652-9484
Mailing Address - Fax:
Practice Address - Street 1:2491 RAYSTOWN RD
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:PA
Practice Address - Zip Code:15537-4959
Practice Address - Country:US
Practice Address - Phone:814-652-9484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE1005477225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA