Provider Demographics
NPI:1366740862
Name:PETRIN, HEIDI LYNN
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:LYNN
Last Name:PETRIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:
Other - Last Name:LINES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:PO BOX 49
Mailing Address - Street 2:28 LORENT DRIVE
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03284
Mailing Address - Country:US
Mailing Address - Phone:603-763-4583
Mailing Address - Fax:
Practice Address - Street 1:28 LORENT DRIVE
Practice Address - Street 2:
Practice Address - City:SPRINFIELD
Practice Address - State:NH
Practice Address - Zip Code:03284
Practice Address - Country:US
Practice Address - Phone:603-763-4583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0656225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant