Provider Demographics
NPI:1558659938
Name:HEEG, ERIC LEE (PTA)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:LEE
Last Name:HEEG
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 S ENGLISH STATION RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-4160
Mailing Address - Country:US
Mailing Address - Phone:502-245-1136
Mailing Address - Fax:502-245-1146
Practice Address - Street 1:175 S ENGLISH STATION RD
Practice Address - Street 2:SUITE 220
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-4160
Practice Address - Country:US
Practice Address - Phone:502-245-1136
Practice Address - Fax:502-245-1146
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA026972251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic