Provider Demographics
NPI:1043861131
Name:BROMAGHIN, HEATHER (PT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:BROMAGHIN
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 1:10331 RED CEDAR CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-5392
Mailing Address - Country:US
Mailing Address - Phone:907-529-4838
Mailing Address - Fax:
Practice Address - Street 1:1110 MAIN STREET
Practice Address - Street 2:
Practice Address - City:HARRINGTON
Practice Address - State:ME
Practice Address - Zip Code:04643
Practice Address - Country:US
Practice Address - Phone:207-483-4022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist