Provider Demographics
NPI:1568804722
Name:HEINZ, DARLENE ANNE (PT)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:ANNE
Last Name:HEINZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6960 DESTINY DR
Mailing Address - Street 2:SUITE 112
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-2993
Mailing Address - Country:US
Mailing Address - Phone:916-415-0119
Mailing Address - Fax:916-415-0120
Practice Address - Street 1:6960 DESTINY DR
Practice Address - Street 2:SUITE 112
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-2993
Practice Address - Country:US
Practice Address - Phone:916-145-0119
Practice Address - Fax:916-415-0120
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25495225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist