=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386241016
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEIDI LYNN MARKERT PTA , LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2020
-----------------------------------------------------
Last Update Date | 10/06/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1395 S OCEAN BLVD APT 604
-----------------------------------------------------
City | POMPANO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33062-7179
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-739-7739
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1395 S OCEAN BLVD APT 604
-----------------------------------------------------
City | POMPANO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33062-7179
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-739-7739
-----------------------------------------------------
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 | 395400
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------