Provider Demographics
NPI:1134852585
Name:SEALEY, HEATHER EUGENIA (PTA)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:EUGENIA
Last Name:SEALEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3198 UNION CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-7327
Mailing Address - Country:US
Mailing Address - Phone:910-733-6732
Mailing Address - Fax:
Practice Address - Street 1:5701 N FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28360-2163
Practice Address - Country:US
Practice Address - Phone:910-739-2821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-04
Last Update Date:2022-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA3668225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant