Provider Demographics
NPI:1225453194
Name:HEIDT, MICHAEL (DPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:HEIDT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:4715 N 32ND ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-3300
Mailing Address - Country:US
Mailing Address - Phone:480-689-5520
Mailing Address - Fax:480-706-7409
Practice Address - Street 1:3271 N CIVIC CENTER PLZ
Practice Address - Street 2:SUITE 3
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6990
Practice Address - Country:US
Practice Address - Phone:480-945-0030
Practice Address - Fax:480-949-4574
Is Sole Proprietor?:No
Enumeration Date:2014-02-28
Last Update Date:2014-02-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ9965225100000X
2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic