Provider Demographics
NPI:1346677374
Name:HEINBAUGH, DANIEL JEFFREY (ATC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JEFFREY
Last Name:HEINBAUGH
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24113 WOODFIELD SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20882-3808
Mailing Address - Country:US
Mailing Address - Phone:301-253-0742
Mailing Address - Fax:
Practice Address - Street 1:24113 WOODFIELD SCHOOL RD
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20882-3808
Practice Address - Country:US
Practice Address - Phone:301-253-0742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-04
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer