MEDICARE: MARIAH HEATON DPT

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	225100000X	Physical Therapist	1852	SD

General Provider Information

NPI Number	:	1508287301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAH HEATON DPT

Provider Business Mailing Address
First Line	:	1110 W OMAHA ST STE 3
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-8097
Country	:	US
Telephone Number	:	605-721-5950
Fax Number	:

Provider Business Practice Location Address
First Line	:	1110 W OMAHA ST STE 3
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-8097
Country	:	US
Telephone Number	:	605-721-5950
Fax Number	:

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

Provider Enumeration Date	:	12/20/2013
Last Update Date	:	07/27/2023

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Directions to “ MARIAH HEATON DPT” Practice Location

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