1871068163 NPI number — MRS. KRISTINA ELLEN HEITZ PHYSICAL THERAPY

Table of content: MRS. KRISTINA ELLEN HEITZ PHYSICAL THERAPY (NPI 1871068163)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871068163 NPI number — MRS. KRISTINA ELLEN HEITZ PHYSICAL THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEITZ
Provider First Name:
KRISTINA
Provider Middle Name:
ELLEN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHYSICAL THERAPY
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HICKENBOTTOM
Provider Other First Name:
KRISTINA
Provider Other Middle Name:
ELLEN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871068163
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1175 BEVERLY PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELKINS
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26241-9759
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-636-1391
Provider Business Mailing Address Fax Number:
304-636-1138

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1175 BEVERLY PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKINS
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26241-9759
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-636-1391
Provider Business Practice Location Address Fax Number:
304-636-1138
Provider Enumeration Date:
10/12/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT004015 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com