Healthcare Provider Details

I. General information

NPI: 1639423726
Provider Name (Legal Business Name): HEATHER LYN MANNING P.T.A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2012
Last Update Date: 10/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 CONDITO RD
HINGHAM MA
02043-1746
US

IV. Provider business mailing address

81 GREAT HILL DR
WEYMOUTH MA
02191-1905
US

V. Phone/Fax

Practice location:
  • Phone: 781-749-2057
  • Fax:
Mailing address:
  • Phone: 617-645-3545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number3987
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: