Healthcare Provider Details

I. General information

NPI: 1679500839
Provider Name (Legal Business Name): EDWARD J. HELLER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

478 WILLIAMSON RD STE E
MOORESVILLE NC
28117-9109
US

IV. Provider business mailing address

478 WILLIAMSON RD STE E
MOORESVILLE NC
28117-9109
US

V. Phone/Fax

Practice location:
  • Phone: 704-696-8223
  • Fax: 704-696-8231
Mailing address:
  • Phone: 704-696-8223
  • Fax: 704-696-8231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP10152
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: