Provider Demographics
NPI:1861730574
Name:HAIN, HEATHER ANN
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANN
Last Name:HAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 STULL RD
Mailing Address - Street 2:
Mailing Address - City:BEAVER SPRINGS
Mailing Address - State:PA
Mailing Address - Zip Code:17812-9327
Mailing Address - Country:US
Mailing Address - Phone:570-658-2247
Mailing Address - Fax:
Practice Address - Street 1:51 ROUTE 204
Practice Address - Street 2:
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-8066
Practice Address - Country:US
Practice Address - Phone:570-372-2384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI000060225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant