Provider Demographics
NPI:1316404460
Name:HEATHCO, CHARLES W III (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:W
Last Name:HEATHCO
Suffix:III
Gender:M
Credentials:PHYSICAL THERAPIST
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Mailing Address - Street 1:28801 HEDGEROW
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-1023
Mailing Address - Country:US
Mailing Address - Phone:949-735-7449
Mailing Address - Fax:
Practice Address - Street 1:28801 HEDGEROW
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-1023
Practice Address - Country:US
Practice Address - Phone:949-735-7449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT7601225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist