Provider Demographics
NPI:1538491584
Name:HEISEY, DONALD CHRISTOPHER (DPT)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:CHRISTOPHER
Last Name:HEISEY
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 1:5411 BASSWOOD BLVD STE 225
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-4479
Mailing Address - Country:US
Mailing Address - Phone:817-498-0700
Mailing Address - Fax:817-498-0813
Practice Address - Street 1:5411 BASSWOOD BLVD STE 225
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-4479
Practice Address - Country:US
Practice Address - Phone:817-498-0700
Practice Address - Fax:817-498-0813
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1194239225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist