Provider Demographics
NPI:1306841549
Name:HECKMANN, TIMOTHY P (PT/AT)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:P
Last Name:HECKMANN
Suffix:
Gender:M
Credentials:PT/AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10663 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4403
Mailing Address - Country:US
Mailing Address - Phone:513-347-9999
Mailing Address - Fax:513-792-3230
Practice Address - Street 1:10663 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4403
Practice Address - Country:US
Practice Address - Phone:513-347-9999
Practice Address - Fax:513-792-3230
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT030062251X0800X
KYPT19612251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2526403Medicaid
KY8700153300Medicaid
KY0239487Medicare PIN
OH2526403Medicaid