Provider Demographics
NPI:1346542966
Name:HEIKKA, SCOTT DANIEL (LMT)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:DANIEL
Last Name:HEIKKA
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 18TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-4935
Mailing Address - Country:US
Mailing Address - Phone:727-851-2577
Mailing Address - Fax:
Practice Address - Street 1:2701 18TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-4935
Practice Address - Country:US
Practice Address - Phone:727-851-2577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA# 10674174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL675736700Medicaid