Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 1407 | NH |
NPI | 1013685841 |
---|---|
Provider Name | Cameron Heroux |
First Address | Weare, NH 03281-5930 |
Second Address | Manchester, NH 03102-8993 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2021 |
Last Update Date | 06/09/2021 |