Provider Demographics
NPI:1164616322
Name:HEINTZ, SUSAN MARIE (PT)
Entity Type:Individual
Prefix:MR
First Name:SUSAN
Middle Name:MARIE
Last Name:HEINTZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6002 HIGHWAY 53
Mailing Address - Street 2:E. #100
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534
Mailing Address - Country:US
Mailing Address - Phone:706-265-8790
Mailing Address - Fax:
Practice Address - Street 1:6002 HIGHWAY 53
Practice Address - Street 2:E. #100
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534
Practice Address - Country:US
Practice Address - Phone:706-265-8790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3104225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist