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General NPI Number Information
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NPI Number | 1144792748
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Entity Type | Individual
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Provider Name | HEATHER MARIA CANTWELL
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Gender | Female
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Dates
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Enumeration Date | 12/20/2018
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Last Update Date | 12/20/2018
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Provider Practice Location Address
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Address Line | 2815 S PENNSYLVANIA AVE
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City | LANSING
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State | MI
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Zip | 48910-3495
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Country | US
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Telephone | 517-975-9900
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Fax |
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Provider Business Mailing Address
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Address Line | 305 N NELSON ST
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City | POTTERVILLE
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State | MI
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Zip | 48876-8713
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Country | US
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Telephone | 517-648-1646
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Fax |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 5502002604
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License Number State | MI
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