Provider Demographics
NPI:1679500839
Name:HELLER, EDWARD J (PT)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:J
Last Name:HELLER
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:478 WILLIAMSON RD STE E
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9109
Mailing Address - Country:US
Mailing Address - Phone:704-696-8223
Mailing Address - Fax:704-696-8231
Practice Address - Street 1:478 WILLIAMSON RD STE E
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9109
Practice Address - Country:US
Practice Address - Phone:704-696-8223
Practice Address - Fax:704-696-8231
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP10152225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211794Medicaid
NC7211794Medicaid