Provider Demographics
NPI:1285856062
Name:HECKENKAMP, DOUGLAS T (MPT)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:T
Last Name:HECKENKAMP
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 HAPPY CANYON RD STE 145
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-3915
Mailing Address - Country:US
Mailing Address - Phone:720-733-3655
Mailing Address - Fax:720-733-3656
Practice Address - Street 1:880 W HAPPY CANYON RD
Practice Address - Street 2:SUITE 145
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-3913
Practice Address - Country:US
Practice Address - Phone:720-733-3655
Practice Address - Fax:720-733-3656
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6646225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC457658Medicare PIN