Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports |
NPI | 1497399158 |
---|---|
Provider Name | Landon Heeres |
First Address | Holland, OH 43528 |
Second Address | Toledo, OH 43615 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2019 |
Last Update Date | 16/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0385791 | (05) | OH |