Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 002748 | CT |
NPI | 1013000322 |
---|---|
Provider Name | Jeffrey R. Heintz |
First Address | Wallingford, CT 06492-5307 |
Second Address | East Hartford, CT 06108-0968 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 08/07/2007 |