Healthcare Provider Details

I. General information

NPI: 1770520652
Provider Name (Legal Business Name): DEBORAH B. HEILMAN MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 WILCOX LN
PORTLAND CT
06480-1002
US

IV. Provider business mailing address

25 WILCOX LN
PORTLAND CT
06480-1002
US

V. Phone/Fax

Practice location:
  • Phone: 860-604-8960
  • Fax:
Mailing address:
  • Phone: 860-604-8960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number006527
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: