Healthcare Provider Details

I. General information

NPI: 1740510049
Provider Name (Legal Business Name): DEBORAH A HLEDIK LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2010
Last Update Date: 12/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 NASON ST
MAYNARD MA
01754-2501
US

IV. Provider business mailing address

6 PLEASANT ST
MAYNARD MA
01754-1332
US

V. Phone/Fax

Practice location:
  • Phone: 978-897-6066
  • Fax: 978-897-5059
Mailing address:
  • Phone: 978-897-6066
  • Fax: 978-897-5059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number2572
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: