Provider Demographics
NPI:1114187523
Name:HEINZMANN, PAUL T (PT, MBA)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:T
Last Name:HEINZMANN
Suffix:
Gender:M
Credentials:PT, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4480 MOUNT HOPE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49690-9209
Mailing Address - Country:US
Mailing Address - Phone:231-938-2425
Mailing Address - Fax:231-938-2453
Practice Address - Street 1:4480 MOUNT HOPE RD
Practice Address - Street 2:SUITE A
Practice Address - City:WILLIAMSBURG
Practice Address - State:MI
Practice Address - Zip Code:49690-9209
Practice Address - Country:US
Practice Address - Phone:231-938-2425
Practice Address - Fax:231-938-2453
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501002327225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1649216144OtherGROUP NPI
MI30046OtherBCBS
MI30814OtherBCN
MI1114187523OtherNPI
MI236850Medicare Oscar/Certification