Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT 24230 | FL |
NPI | 1003067224 |
---|---|
Provider Name | Megan M Heintz |
First Address | Orlando, FL 32891-7770 |
Second Address | Tampa, FL 33612-6601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2008 |
Last Update Date | 14/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000198100 | (05) | FL |
Y133Y | BLUE CROSS BLUE SHIELD (01) | FL |