Provider Demographics
NPI:1184010720
Name:HEYWARD, JAMES MARION JR (PTA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MARION
Last Name:HEYWARD
Suffix:JR
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:MARION
Other - Last Name:HEYWARD
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:2401 RESEARCH BLVD
Mailing Address - Street 2:109
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3215
Mailing Address - Country:US
Mailing Address - Phone:301-657-5651
Mailing Address - Fax:
Practice Address - Street 1:2401 RESEARCH BLVD
Practice Address - Street 2:109
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3215
Practice Address - Country:US
Practice Address - Phone:301-657-5651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-10
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPTA000125225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant