Provider Demographics
NPI:1386241016
Name:MARKERT, HEIDI LYNN (PTA , LMT)
Entity type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:LYNN
Last Name:MARKERT
Suffix:
Gender:F
Credentials:PTA , LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1395 S OCEAN BLVD APT 604
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-7179
Mailing Address - Country:US
Mailing Address - Phone:757-739-7739
Mailing Address - Fax:
Practice Address - Street 1:1395 S OCEAN BLVD APT 604
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-7179
Practice Address - Country:US
Practice Address - Phone:757-739-7739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL395400225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist