Provider Demographics
NPI:1346676442
Name:HEINEN, BRICE C (DPT)
Entity Type:Individual
Prefix:DR
First Name:BRICE
Middle Name:C
Last Name:HEINEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2916 CORNWALL PL
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-4306
Mailing Address - Country:US
Mailing Address - Phone:405-831-7468
Mailing Address - Fax:405-242-3057
Practice Address - Street 1:3000 UNITED FOUNDERS BLVD STE 141S
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-3958
Practice Address - Country:US
Practice Address - Phone:405-831-7468
Practice Address - Fax:405-242-3057
Is Sole Proprietor?:No
Enumeration Date:2013-09-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4762225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist