Provider Demographics
NPI:1497846844
Name:HEYER, EHREN PAUL (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:EHREN
Middle Name:PAUL
Last Name:HEYER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 CORTLAND ST.
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:NY
Mailing Address - Zip Code:13077
Mailing Address - Country:US
Mailing Address - Phone:607-749-2219
Mailing Address - Fax:607-749-2286
Practice Address - Street 1:84 CORTLAND ST.
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:NY
Practice Address - Zip Code:13077
Practice Address - Country:US
Practice Address - Phone:607-749-2219
Practice Address - Fax:607-749-2286
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0258401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000158530OtherHMO
NY000158530OtherBCBS
NY02565451Medicaid
NY56533AMedicare ID - Type Unspecified
NY02565451Medicaid