MEDICARE: HEATHER L VEZINA PT

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	174400000X	Specialist	2937	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154493799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER L VEZINA PT

Provider Business Mailing Address
First Line	:	1941 MAHOGANY DR
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-2451
Country	:	US
Telephone Number	:	505-523-7243
Fax Number	:	505-523-7254

Provider Business Practice Location Address
First Line	:	301 PERKINS DR STE B
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88005-3248
Country	:	US
Telephone Number	:	505-523-7243
Fax Number	:	505-523-7254

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

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	07/09/2007

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Directions to “ HEATHER L VEZINA PT” Practice Location

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