Healthcare Provider Details

I. General information

NPI: 1336534817
Provider Name (Legal Business Name): HEIDI PUTMAN M.P.T
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 04/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 ARCADIA LN
HICKSVILLE NY
11801-4437
US

IV. Provider business mailing address

6 ARCADIA LN
HICKSVILLE NY
11801-4437
US

V. Phone/Fax

Practice location:
  • Phone: 516-659-8252
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number007013
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: