Provider Demographics
NPI:1679106629
Name:RAND, HEATHER JEAN (DPT, MS)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:JEAN
Last Name:RAND
Suffix:
Gender:F
Credentials:DPT, MS
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:JEAN
Other - Last Name:THEISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT, MS
Mailing Address - Street 1:3 CATHERINE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2701
Mailing Address - Country:US
Mailing Address - Phone:347-414-0843
Mailing Address - Fax:
Practice Address - Street 1:22 BRAMHALL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3134
Practice Address - Country:US
Practice Address - Phone:207-662-4800
Practice Address - Fax:207-662-3185
Is Sole Proprietor?:No
Enumeration Date:2020-02-18
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT5506225100000X
NY038947-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist