MEDICARE: MRS. HEATHER EUGENIA SEALEY PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	A3668	NC

General Provider Information

NPI Number	:	1134852585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HEATHER EUGENIA SEALEY PTA

Provider Business Mailing Address
First Line	:	3198 UNION CHAPEL RD
Second Line	:
City	:	PEMBROKE
State	:	NC
Zip	:	28372-7327
Country	:	US
Telephone Number	:	910-733-6732
Fax Number	:

Provider Business Practice Location Address
First Line	:	5701 N FAYETTEVILLE RD
Second Line	:
City	:	LUMBERTON
State	:	NC
Zip	:	28360-2163
Country	:	US
Telephone Number	:	910-739-2821
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/04/2022
Last Update Date	:	07/04/2022

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