Healthcare Provider Details

I. General information

NPI: 1780639732
Provider Name (Legal Business Name): BARBARA BACON HEIL PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 10/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 FEATHER HILL RD
WESTPORT CT
06880-1846
US

IV. Provider business mailing address

3 FEATHER HILL RD
WESTPORT CT
06880-1846
US

V. Phone/Fax

Practice location:
  • Phone: 203-227-5888
  • Fax:
Mailing address:
  • Phone: 203-227-5888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number007477
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: