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General NPI Number Information
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NPI Number | 1134466014
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Entity Type | Individual
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Provider Name | HEIDI L NILES DPT
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Gender | Female
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Dates
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Enumeration Date | 01/11/2013
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Last Update Date | 04/07/2021
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Provider Practice Location Address
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Address Line | 17 2ND ST
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City | BANGOR
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State | ME
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Zip | 04401-6133
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Country | US
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Telephone | 207-907-0744
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 19
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City | HOLDEN
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State | ME
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Zip | 04429-0019
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Country | US
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Telephone | 207-907-0744
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Fax | 207-800-4960
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT28040
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 13837
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT3963
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License Number State | ME
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