Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 9965 | AZ |
N | 2251S0007X | Physical Therapist - Sports | ||
N | 2251X0800X | Physical Therapist - Orthopedic |
NPI | 1225453194 |
---|---|
Provider Name | Michael Heidt |
First Address | Phoenix, AZ 85018-3300 |
Second Address | Scottsdale, AZ 85251-6990 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2014 |
Last Update Date | 28/02/2014 |