Provider Demographics
NPI:1013000322
Name:HEINTZ, JEFFREY R (MS, PT, ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:R
Last Name:HEINTZ
Suffix:
Gender:M
Credentials:MS, PT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 W DAYTON HILL RD
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-5307
Mailing Address - Country:US
Mailing Address - Phone:860-565-1089
Mailing Address - Fax:860-565-6348
Practice Address - Street 1:400 MAIN ST
Practice Address - Street 2:MEDICAL DEPT., MS 124-10
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-0968
Practice Address - Country:US
Practice Address - Phone:860-565-1089
Practice Address - Fax:860-565-6348
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0027482251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic