Healthcare Provider Details

I. General information

NPI: 1649957010
Provider Name (Legal Business Name): LAUREN HEULITT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2023
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 SEBASTICOOK ST
PITTSFIELD ME
04967-4107
US

IV. Provider business mailing address

114 DONIGAN RD
MOSCOW ME
04920-3136
US

V. Phone/Fax

Practice location:
  • Phone: 207-416-5236
  • Fax:
Mailing address:
  • Phone: 732-966-4810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number0794544
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: