Provider Demographics
NPI:1932350014
Name:CARON, HEATHER ALICE (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:ALICE
Last Name:CARON
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:ALICE
Other - Last Name:FRENCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:5 NORTH STREET
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-2240
Mailing Address - Country:US
Mailing Address - Phone:207-769-2160
Mailing Address - Fax:207-769-2161
Practice Address - Street 1:5 NORTH STREET
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-2240
Practice Address - Country:US
Practice Address - Phone:207-769-2160
Practice Address - Fax:207-769-2161
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME265080099Medicaid