Provider Demographics
NPI:1114423589
Name:HEFFLINGER, DYLAN (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:
Last Name:HEFFLINGER
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15361 POTTER RD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:OH
Mailing Address - Zip Code:43569-9760
Mailing Address - Country:US
Mailing Address - Phone:419-308-2310
Mailing Address - Fax:
Practice Address - Street 1:15361 POTTER RD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:OH
Practice Address - Zip Code:43569-9760
Practice Address - Country:US
Practice Address - Phone:419-308-2310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0055442255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer