Provider Demographics
NPI:1457065013
Name:HEUCHEMER, LAURA HEUCHEMER (LPTA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:HEUCHEMER
Last Name:HEUCHEMER
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NM
Mailing Address - Zip Code:88415-2909
Mailing Address - Country:US
Mailing Address - Phone:505-382-1126
Mailing Address - Fax:
Practice Address - Street 1:300 WILSON ST
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NM
Practice Address - Zip Code:88415-3304
Practice Address - Country:US
Practice Address - Phone:575-374-5733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPTA0568225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant