MEDICARE: HEATHER L NORTH 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	225100000X	Physical Therapist	PT016319	PA
2	225100000X	Physical Therapist	021601-1	NY

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	:	1619926698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER L NORTH PT

Provider Business Mailing Address
First Line	:	120 GRANDVIEW DR
Second Line	:
City	:	AMHERST
State	:	NY
Zip	:	14228-1858
Country	:	US
Telephone Number	:	716-417-4390
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 COLLEGE PKWY
Second Line	:	SUITE 100
City	:	AMHERST
State	:	NY
Zip	:	14221-6800
Country	:	US
Telephone Number	:	716-626-0093
Fax Number	:	716-626-9193

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

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	10/22/2007

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Directions to “ HEATHER L NORTH PT” Practice Location

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