Provider Demographics
NPI:1780350843
Name:MARTIN, HEATHER NOEL (PT)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:NOEL
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:NOEL
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:40 S RIVER RD UNIT 58
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6751
Mailing Address - Country:US
Mailing Address - Phone:603-626-4205
Mailing Address - Fax:603-666-6617
Practice Address - Street 1:76 NORTHEASTERN BLVD STE 24B
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-3174
Practice Address - Country:US
Practice Address - Phone:603-943-5029
Practice Address - Fax:603-943-7066
Is Sole Proprietor?:No
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH4859225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist