MEDICARE: HEATHER POPP DPT, NCS

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	19374	MA
2	2081N0008X	Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician	19374	MA

General Provider Information

NPI Number	:	1902356892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER POPP DPT, NCS

Provider Business Mailing Address
First Line	:	4 AMES ST
Second Line	:
City	:	SALEM
State	:	MA
Zip	:	01970-2610
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	148 CANDLESTICK RD
Second Line	:
City	:	NORTH ANDOVER
State	:	MA
Zip	:	01845-3238
Country	:	US
Telephone Number	:	978-317-9491
Fax Number	:

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

Provider Enumeration Date	:	10/04/2016
Last Update Date	:	04/12/2023

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