Healthcare Provider Details

I. General information

NPI: 1508823345
Provider Name (Legal Business Name): HEATHER BEAL ANDERSON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 MAIN ST.
HARRINGTON ME
04643-0220
US

IV. Provider business mailing address

P.O. BOX 220 1110 MAIN ST.
HARRINGTON ME
04643-0220
US

V. Phone/Fax

Practice location:
  • Phone: 204-483-4022
  • Fax: 207-483-9722
Mailing address:
  • Phone: 204-483-4022
  • Fax: 207-483-9722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT2403
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: