Individual
MARY M HECKEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
448 S MAPLE GROVE ROAD, BOISE, ID 83709
(208) 859-9953
(208) 629-3155
Mailing address
4488 YORGASON WAY, BOISE, ID 83703-3146
(208) 859-9953
(208) 629-3155
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT1046
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010148543
REGENCE BLUE SHIELD OF ID
ID
01
—
TA484
BLUE CROSS OF IDAHO
ID
Enumeration date
01/18/2007
Last updated
07/08/2007
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