=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356969646
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHERYL HEBERT LMT, BCBTMB, CZB
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2020
-----------------------------------------------------
Last Update Date | 07/13/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 75 NEWPORT RD UNIT 12
-----------------------------------------------------
City | NEW LONDON
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03257-5467
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-526-2879
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8 ROWELL HILL RD
-----------------------------------------------------
City | NEW LONDON
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03257-7106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 1487M
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------