Provider Demographics
NPI:1831527076
Name:HERON, NADINE (PT, DPT)
Entity type:Individual
Prefix:
First Name:NADINE
Middle Name:
Last Name:HERON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1755 DREXEL RD
Mailing Address - Street 2:
Mailing Address - City:DUNDALK
Mailing Address - State:MD
Mailing Address - Zip Code:21222-5040
Mailing Address - Country:US
Mailing Address - Phone:240-344-8777
Mailing Address - Fax:
Practice Address - Street 1:1838 GREENE TREE RD
Practice Address - Street 2:SUITE 290
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-6391
Practice Address - Country:US
Practice Address - Phone:410-653-9813
Practice Address - Fax:410-653-9815
Is Sole Proprietor?:No
Enumeration Date:2013-10-25
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24653225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist