Healthcare Provider Details

I. General information

NPI: 1275199549
Provider Name (Legal Business Name): VALERIE BILHEIMER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2019
Last Update Date: 05/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 MARITIME DR
MYSTIC CT
06355-1958
US

IV. Provider business mailing address

44 MARITIME DR
MYSTIC CT
06355-1958
US

V. Phone/Fax

Practice location:
  • Phone: 860-572-4241
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number000432
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: