Provider Demographics
NPI:1275134538
Name:HEINTZMAN, ELIZABETH EMMA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:EMMA
Last Name:HEINTZMAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:938 76TH AVENUE SOUTH
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104
Mailing Address - Country:US
Mailing Address - Phone:701-799-6335
Mailing Address - Fax:
Practice Address - Street 1:1279 W. FRONTAGE ROAD UNIT H
Practice Address - Street 2:
Practice Address - City:RIO RICO
Practice Address - State:AZ
Practice Address - Zip Code:85648-8029
Practice Address - Country:US
Practice Address - Phone:520-375-2127
Practice Address - Fax:520-375-2127
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2283225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZCP008810TOtherAZ PT COMPACT PRIVILEGE