Provider Demographics
NPI:1720515927
Name:HEAFIELD, NICHOLAS A (PT)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:A
Last Name:HEAFIELD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 PLEASANT ST STE 101
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2547
Mailing Address - Country:US
Mailing Address - Phone:603-228-7500
Mailing Address - Fax:603-228-3503
Practice Address - Street 1:171 PLEASANT ST STE 101
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2547
Practice Address - Country:US
Practice Address - Phone:603-228-7500
Practice Address - Fax:603-228-3503
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH4223225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist