Organization
HETHERINGTON THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NICKOLAS HETHERINGTON MOT, OTR/L, CIMI-II (OWNER)
(989) 450-6441
Entity
Organization
Contact information
Practice address
1634 SALADINO ST SE, PALM BAY, FL 32909-5425
(833) 684-5429
Mailing address
1634 SALADINO ST SE, PALM BAY, FL 32909-5425
(833) 684-5429
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
05/24/2019
Last updated
08/11/2021
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