Provider Demographics
NPI:1073011961
Name:HEILLER, JOSHUA DAVID
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:DAVID
Last Name:HEILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5590 W CHANDLER BLVD STE B4
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-3697
Mailing Address - Country:US
Mailing Address - Phone:480-786-4969
Mailing Address - Fax:480-786-5118
Practice Address - Street 1:5590 W CHANDLER BLVD STE B4
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226
Practice Address - Country:US
Practice Address - Phone:480-786-4969
Practice Address - Fax:480-786-5118
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ013581225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ376073Medicaid