Provider Demographics
NPI:1184821365
Name:HEINZE, DANIELLE KAY (LMT)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:KAY
Last Name:HEINZE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13220 MAPLE ST.
Mailing Address - Street 2:P.O. BOX 35
Mailing Address - City:WESTON
Mailing Address - State:OH
Mailing Address - Zip Code:43569
Mailing Address - Country:US
Mailing Address - Phone:419-669-3450
Mailing Address - Fax:
Practice Address - Street 1:321 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-2424
Practice Address - Country:US
Practice Address - Phone:419-353-3191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.14130174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist