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NPI Code Detail

MEDICARE: HEATHER L VEZINA PT

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
1174400000XSpecialist2937NM

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID 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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