Provider Demographics
NPI:1023304631
Name:DOMMERS-PALLADINO, HEIDI (LMT)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:DOMMERS-PALLADINO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 246
Mailing Address - Street 2:11 WILLAND RD.
Mailing Address - City:CTR. TUFTONBORO
Mailing Address - State:NH
Mailing Address - Zip Code:03816
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:40 PROVINCE LAKE RD
Practice Address - Street 2:
Practice Address - City:SANBORNVILLE
Practice Address - State:NH
Practice Address - Zip Code:03872-3900
Practice Address - Country:US
Practice Address - Phone:603-522-3100
Practice Address - Fax:603-522-5158
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3566M225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist