Provider Demographics
NPI:1174568729
Name:SMART, HEIDI MARTINE (PT)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:MARTINE
Last Name:SMART
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 ROCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-4237
Mailing Address - Country:US
Mailing Address - Phone:207-650-4024
Mailing Address - Fax:
Practice Address - Street 1:4 WINDING WAY
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-8658
Practice Address - Country:US
Practice Address - Phone:207-883-1211
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT1905225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEME1361Medicare ID - Type Unspecified