Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1339076 | TX |
N | 2251G0304X | Physical Therapist - Geriatrics | 1504 | WY |
N | 2251G0304X | Physical Therapist - Geriatrics | 6431 | CT |
NPI | 1215452735 |
---|---|
Provider Name | Mary Heckman |
First Address | Stinnett, TX 79083-7210 |
Second Address | Perryton, TX 79070-5323 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2017 |
Last Update Date | 20/02/2021 |