Provider Demographics
NPI:1003841305
Name:HEYERMAN, JOHN FREDERICK (MSPT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:FREDERICK
Last Name:HEYERMAN
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3115 MARCIA LANE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MI
Mailing Address - Zip Code:49419
Mailing Address - Country:US
Mailing Address - Phone:269-751-6090
Mailing Address - Fax:
Practice Address - Street 1:3491 M40
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MI
Practice Address - Zip Code:49419
Practice Address - Country:US
Practice Address - Phone:269-751-2150
Practice Address - Fax:269-751-2140
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501008369225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
N51840004Medicare ID - Type Unspecified