Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 010235-1 | NY |
NPI | 1073946687 |
---|---|
Provider Name | Paul Jay Heins |
First Address | Syracuse, NY 13212 |
Second Address | Syracuse, NY 13212-2375 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2013 |
Last Update Date | 19/08/2013 |