Individual
MISS HEATHER LYNN WACKSMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT2833
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
098997
ANTHEM BCBS
ME
01
—
11507672
CAQH
—
01
—
2756063001
CIGNA
ME
05
—
432475009
—
ME
01
—
626281
HARVARD PILGRIM
ME
Enumeration date
10/10/2006
Last updated
01/18/2011
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